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Review
. 2023 Nov 3:14:1233710.
doi: 10.3389/fendo.2023.1233710. eCollection 2023.

Bilateral adrenal hemorrhage: learning notes from clinical practice and literature review

Maria Elena Aloini  1 , Sara Manella  2 , Irene Biondo  1 , Roberta Maggio  1 , Guido Roberto  1 , Francesca Ricci  1 , Pina Lardo  1 , Paola Addario Chieco  3 , Antonio Stigliano  1
Affiliations
Review

Bilateral adrenal hemorrhage: learning notes from clinical practice and literature review

Maria Elena Aloini et al. Front Endocrinol (Lausanne). .

Abstract

Adrenal hemorrhage is a rare, but important, diagnosis to recognize, in particular when there is involvement of both adrenal glands. Bilateral adrenal hemorrhage can in fact lead to adrenal insufficiency, with dramatic consequences if not promptly recognized and treated. It is normally caused by systemic conditions that lead to the vasoconstriction and thrombosis of the adrenal vein. Oftentimes, the clinical diagnosis of this condition can be very challenging, as its signs and symptoms are generalized and nonspecific (abdominal pain, nausea, and fatigue). Here, we present the cases of two patients admitted to the Emergency Department in 2016 and 2022 with acute abdominal pain, having recently undergone surgery and subsequently prescribed low-molecular-weight heparin. In both cases, laboratory results revealed neutrophilic leukocytosis and an unexplained anemia. Due to the persistence of abdominal pain despite medication, a CT scan was performed, showing an enlargement of both adrenal glands suggestive of bilateral adrenal hemorrhage. Adrenal function was tested that correlated with a diagnosis of adrenal insufficiency, and both patients were promptly treated with parenteral hydrocortisone as a result. On 5 years' follow-up from the acute event, the second patient's adrenal function had returned to normal, and he has not needed further adrenal replacement therapy; the first patient however demonstrated persistence of adrenal failure requiring replacement therapy. In this paper, through our experience and a literature analysis, we will aim to outline some clues to identify patients at potential risk of bilateral adrenal hemorrhage.

Keywords: abdominal sepsis; acute abdomen; adrenal insufficiency; antiphospholipid syndrome; bilateral adrenal hemorrhage; low molecular weight heparin; orthopedic surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CT scan showing an acute increase of the dimensions (blue arrows) of both adrenal glands in case 1.
Figure 2
Figure 2
CT scan showing an increase of the size of both adrenals (blue arrows) with high density, suggestive for BAH, in case 2.
See this image and copyright information in PMC

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