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Spontaneous Adrenal Hemorrhage—a Mixed Bag: 18 Cases from a Single Institution

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Abstract

Spontaneous adrenal hemorrhage is a rare clinical entity which can lead to an adrenal crisis, shock, and death. We conducted this study to analyze the etiopathogenesis, clinical presentation, imaging modality, and treatment of patients with spontaneous adrenal hemorrhage. Retrospective analysis of 18 patients with spontaneous adrenal hemorrhage managed between 2005 and 2017 at a single institution was performed. The most common presenting symptom was abdominal pain in 10 (55.6%) patients. Contrast-enhanced computerized tomography (CECT) was the most commonly used diagnostic modality (16/18 [88%]). Bilateral adrenal hemorrhage was seen in 6 patients (33%). Adrenal insufficiency was detected in 7 (38.9%) and these patients received steroid therapy. Etiology of the bleed included idiopathic (5 [27.8%]), antiphospholipid antibody syndrome (APLA) (5 [27.8%]), and pheochromocytoma (4 [22.2%]), associated with pregnancy, anticoagulant use, pseudoaneurysm, and myelolipoma in 1 (5.5%) each. Nine (50%) patients could be managed conservatively, and 8 (44.4%) required adrenalectomy while embolization was performed in one (5.6%). There were no mortalities. In this series, the most common clinical presentation of a patient with spontaneous adrenal hemorrhage was abdominal pain. The detection of an unexplained adrenal hemorrhage should prompt one to look for predisposing conditions like APLA. Patients with adrenal hemorrhage should be evaluated for adrenal insufficiency and if present, steroid therapy needs to be initiated. As seen in this series, not all patients with adrenal hemorrhage require an adrenalectomy.

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Authors and Affiliations

  1. Department of Endocrine Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India

    Varghese Thomas, Anish Jacob Cherian, Shawn Sam Thomas, M. J. Paul & D. T. Abraham

  2. Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India

    Arun Philip George & Santhosh Kumar

  3. Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India

    T. V. Paul

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  1. Varghese Thomas
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Correspondence to Anish Jacob Cherian.

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Thomas, V., Cherian, A.J., Thomas, S.S. et al. Spontaneous Adrenal Hemorrhage—a Mixed Bag: 18 Cases from a Single Institution. Indian J Surg 82, 382–386 (2020). https://doi.org/10.1007/s12262-019-01969-2

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