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Adrenal Hemorrhage


Presentation

  • It may be asymptomatic or may present with flank abdominal mass, anemia, jaundice, or rarely as scrotal bruising or hematoma.[ncbi.nlm.nih.gov]
Fever
  • A high index of suspicion for adrenal hemorrhage is required in patients receiving any form of heparin therapy presenting with new onset thrombocytopenia, abdominal pain, and fevers. (c) 2007 Wiley-Liss, Inc.[ncbi.nlm.nih.gov]
Chills
  • He denied fevers, chills, night sweats, recent infections and trauma. Other than aspirin 81 mg daily, he was not taking anticoagulants or anti-platelet agents.[digitalrepository.unm.edu]
  • He denied having had fever, chills, hematuria, or dysuria. History. In the last 2 years, he had had multiple emergency department visits for episodic abdominal pain.[consultant360.com]
  • In reported cases, temperature may range from low-grade fever to high fever with chills. In the setting of adrenal hemorrhage, fever may be associated with adrenal insufficiency, the hematoma itself, or the underlying cause of adrenal hemorrhage.[emedicine.medscape.com]
Inguinal Hernia
  • Bluish discoloration and swelling of the scrotum in newborns can arise from a number of diseases, including torsion of the testes, orchitis, scrotal or testicular edema, hydrocele, inguinal hernia, meconium peritonitis, hematocele, testicular tumor and[ncbi.nlm.nih.gov]
Rigor
  • The onset of the illness is nonspecific with fever, rigors, vomiting, and headache. Soon a rash appears; first macular, not much different from the rose spots of typhoid, and rapidly becoming petechial and purpuric with a dusky gray color.[en.wikipedia.org]
Abdominal Pain
  • A 52-year-old lady with a history of hypertension, dilated cardiomyopathy and diabetes mellitus type 2, presented with severe upper abdominal pain and vomiting of 4 hours duration.[ncbi.nlm.nih.gov]
Vomiting
  • A 52-year-old lady with a history of hypertension, dilated cardiomyopathy and diabetes mellitus type 2, presented with severe upper abdominal pain and vomiting of 4 hours duration.[ncbi.nlm.nih.gov]
  • Nausea and vomiting. Diarrhea Symptoms associated with the underlying condition which is causing the hemorrhage will also be present. Seldom, the condition may be asymptomatic, presenting as an incidental finding during investigations.[simple-remedies.com]
Nausea
  • Abstract The authors report a case of a 56-year-old Thai woman with a history of recurrent venous thrombosis, spontaneous abortion and Graves' disease who presented with bilateral flank pain, nausea, vomiting and low-grade fever followed by hypotension[ncbi.nlm.nih.gov]
  • She had a normal vaginal delivery on the second day of her hospitalization but continued to have left flank pain, as well as nausea, emotional lability, fatigue, and general malaise.[cureus.com]
  • The most common symptoms and signs were flank pain, fever, nausea, vomiting, weakness, fatigue, confusion, and hypotension.[healio.com]
  • Nausea and vomiting. Diarrhea Symptoms associated with the underlying condition which is causing the hemorrhage will also be present. Seldom, the condition may be asymptomatic, presenting as an incidental finding during investigations.[simple-remedies.com]
Acute Abdomen
  • Some patients may present with signs of acute abdomen similar to appendicitis. What Causes Adrenal Hemorrhage? There are several disorders and conditions that may precipitate adrenal hemorrhage.[tandurust.com]
  • Signs of acute abdomen, including guarding, rigidity, or rebound tenderness, have been reported in 15-20% of patients.[emedicine.medscape.com]
Hypotension
  • Adrenal crisis from bilateral adrenal hemorrhage was diagnosed by a low serum cortisol level during hypotension and bilateral hyperdense oval masses in each of the adrenal glands in a computerized tomographic study.[ncbi.nlm.nih.gov]
Tachycardia
  • Within 6 h after delivery, the patient showed pallor without tachycardia and hypotension. In laboratory studies, hemoglobin level failed from 14 g/dL to 10 g/dL within 6 h. Physical examination revealed no signs of abdominal mass.[ncbi.nlm.nih.gov]
  • On postoperative day (POD) 2, she developed new-onset sinus tachycardia and showed depressed pulse-oximetry readings.[f1000research.com]
  • Tachycardia and hypotension are late signs.[mitchmedical.us]
  • Clinical manifestations, such as fever, tachycardia, hypotension, lethargy, and electrolyte disturbances, commonly occur in postoperative patients as well.[healio.com]
  • The most common symptoms are hypotension, confusion, lethargy, nausea, vomiting, tachycardia, and fever. More specific symptoms such as central abdominal pain radiating to the flank are experienced by 45% of the patients.[asean-endocrinejournal.org]
Eczema
  • Typische Wortverbindungen und Kollokationen Keine direkten Treffer für scrotal im Wörterbuch gefunden. scrotal tongue scrotal hernoa scrotal hernia scrotal reflex scrotal dermatitis scrotal eczema scrotal calculus scrotal hydrocele scrotal hypospadia[linguatools.com]
Skin Discoloration
  • Case report of a neonate presenting within 1 h of birth with right side scrotal swelling and a dusky skin discoloration thought clinically to be a hydrocele or testicular torsion.[ncbi.nlm.nih.gov]
Altered Mental Status
  • The most common presenting symptom was abdominal pain (n 6), followed by altered mental status and shock (2) and hypercortisolism (1). Five patients were asymptomatic. In 10 patients the adrenal tumor was metastatic.[ncbi.nlm.nih.gov]
Oliguria
  • We report two cases of AH in neonates; the first presented with scrotal hematoma and the second with adrenal mass associated with hypertension and oliguria, primarily secondary to coincidental renal vein thrombosis.[ncbi.nlm.nih.gov]
Swelling of the Scrotum
  • Bluish discoloration and swelling of the scrotum in newborns can arise from a number of diseases, including torsion of the testes, orchitis, scrotal or testicular edema, hydrocele, inguinal hernia, meconium peritonitis, hematocele, testicular tumor and[ncbi.nlm.nih.gov]

Workup

  • If on the unenhanced-CT the density is equal to or below 10 HU the lesion is considered to be an adenoma and no further workup is neccessary If the density is more than 10 HU the wash out should be calculated.[radiologyassistant.nl]
Aldosterone Increased
  • Repeated Synacthen tests showed complete absence of response in 8 of the 10 patients assessed; cortisol and aldosterone increased appropriately in one patient and to some extent in another one.[ncbi.nlm.nih.gov]
Hyponatremia
  • Abstract We present the case of a 56-year-old man with an upper respiratory infection followed by fatigue, hypotension, and hyponatremia. Bilateral adrenal hemorrhage was confirmed, based on T2-weighted magnetic resonance imaging.[ncbi.nlm.nih.gov]
  • Hydration and correction of the hyponatremia are necessary. Large doses of hydrocortisone, FIGURE 72-2.[mitchmedical.us]
  • While she did not take steroid therapy, the subject of this case report developed hypotension, hyponatremia, and hyperkaliema owing to an acute adrenal insufficiency.[academic.oup.com]
  • Laboratory analysis at that time was remarkable for a leukocytosis to (16,000/µL), thrombocytopenia of 49,000/µL (from a pre-operative value of 234,000/µL), hyponatremia to 125mEq/L (baseline of 139mEq/L) and a relatively normal HCT of 31.7%.[f1000research.com]
Pancreatic Necrosis
  • A repeated computerized tomography scan showed severe pancreatic necrosis and right adrenal hemorrhage.[ncbi.nlm.nih.gov]

Treatment

  • Corticosteroid treatment in situations of severe stress or sepsis had little effect on outcome (9% vs. 6% survival with and without corticosteroid treatment, respectively).[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis of acute bilateral adrenal hemorrhage remains good so long as patients undergo appropriate treatment, including anticoagulation and corticosteroid replacement therapy.[consultant360.com]

Etiology

  • Adrenal hemorrhage has many etiologies including bleeding diathesis. A 10-day-old female baby was admitted to our clinic with the complaint of abdominal distention.[ncbi.nlm.nih.gov]
  • Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg. 2012 Jan. 36(1):75-82. [Medline]. Diolombi ML, Khani F, Epstein JI.[emedicine.medscape.com]

Epidemiology

  • Epidemiology Frequency United States Adrenal hemorrhage has been reported in 0.3-1.8% of unselected cases in autopsy studies, although extensive bilateral adrenal hemorrhage may be present in 15% of individuals who die of shock.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • They reviewed the existing theories of the pathophysiology of adrenal insufficiency in the burn patient. Vaughan and associates demonstrated Cortisol levels three to four times higher than normal in patients with burns greater than 30%.[mitchmedical.us]
  • Several pathophysiological changes during the intraoperative and postoperative period make the adrenal gland susceptible to adrenal haemorrhage.[endocrine-abstracts.org]
  • Pathophysiology Although the precise mechanisms leading to adrenal hemorrhage are unclear in nontraumatic cases, available evidence has implicated adrenocorticotropic hormone (ACTH), adrenal vein spasm and thrombosis, and the normally limited venous drainage[emedicine.medscape.com]
  • Elevated ACTH level is the proposed hypothesis as pathophysiology in the context of sepsis from amoebic liver abscess (2). This is based on animal studies (3).[edmcasereports.com]

Prevention

  • She was discharged on long-term glucocorticoid replacement for her primary adrenal insufficiency as well as an anticoagulant for prevention of thrombosis.[ncbi.nlm.nih.gov]
  • Once detected of adrenal hemorrhage, medicines are given to replace the function of adrenal gland and prevent adrenal crisis. Symptomatic treatment is administered to correct loss of body fluid and electrolyte.[tandurust.com]

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