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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]
  • The case of a newborn with right adrenal hemorrhage presenting as left scrotal hematoma is reported.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: A 49-year-old white woman re-presented to hospital with a history suggestive of sepsis. She had a medical background of primary antiphospholipid syndrome on lifelong warfarin.[ncbi.nlm.nih.gov]
  • The review of these patients emphasizes the subtle and diverse clinical presentation of adrenal hemorrhage in a neonate and stresses the importance of abdominal sonography in establishing the diagnosis.[ncbi.nlm.nih.gov]
  • A review of the pertinent literature is presented.[ncbi.nlm.nih.gov]
Fever
  • On the 3rd day she developed fever, increasing abdominal pain and shortness of breath. A repeated computerized tomography scan showed severe pancreatic necrosis and right adrenal hemorrhage.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • It is difficult to diagnose clinically, particularly in critically ill patients, given its non-specific symptoms and signs, which include abdominal pain, vomiting, fever, weakness, hypotension, and altered conscious state.[ncbi.nlm.nih.gov]
  • Abstract A 29-yr-old man, presented with abdominal pain and fever, had an initial computed tomography (CT) scan revealing low attenuation of both adrenal glands.[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]
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
  • Abstract 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]
  • A 54-year-old woman with stage IV non-small-cell lung cancer and known bilateral adrenal metastasis developed severe right-sided abdominal pain while undergoing chemotherapy treatment.[ncbi.nlm.nih.gov]
  • Patients who have abdominal pain, hypotension, or both soon after initiation of anticoagulation or patients who experience abdominal pain, fever, nausea, or confusion postoperatively should be screened for AH. Copyright 2014, SLACK Incorporated.[ncbi.nlm.nih.gov]
  • 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]
  • Abstract A 55-year-old man was transported to our hospital after a sudden onset of left lower abdominal pain while driving.[ncbi.nlm.nih.gov]
Vomiting
  • Abstract 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]
  • 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]
  • Four babies (22%) had poor oral feeding combined with vomiting. Only one had severe anemia for which blood transfusion was required. There were no cases of adrenocortical insufficiency in our study. Only one patient received adrenalectomy.[ncbi.nlm.nih.gov]
  • It is difficult to diagnose clinically, particularly in critically ill patients, given its non-specific symptoms and signs, which include abdominal pain, vomiting, fever, weakness, hypotension, and altered conscious state.[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]
  • Patients who have abdominal pain, hypotension, or both soon after initiation of anticoagulation or patients who experience abdominal pain, fever, nausea, or confusion postoperatively should be screened for AH. Copyright 2014, SLACK Incorporated.[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]
  • 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]
  • Gastrointestinal symptoms such as anorexia, nausea, vomiting, constipation and diarrhea alternating are other symptoms. Fever is present as a result of hematoma. There may be low grade or high grade fever.[tandurust.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]
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]
  • Non-traumatic adrenal hemorrhage has been observed to occur in times of physiological stress, such as post-surgery, sepsis, burns, and hypotension.[ncbi.nlm.nih.gov]
  • The clinical manifestations included most often an abdominal mass but also anemia, jaundice, hypotension, bluish discoloration of the scrotum, and abdominal calcification.[ncbi.nlm.nih.gov]
  • It can be associated with birth trauma, large birth weight, or neonatal course complicated by hypoxia and asphyxia, hypotension, or coagulopathy. Scrotal hematoma is an extremely rare manifestation of NAH.[ncbi.nlm.nih.gov]
  • Abstract We report a 67-year-old man who presented with sudden onset of pain in the left flank in association with anemia and hypotension.[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]
  • After initial recovery, he had clinical deterioration on day 3 after the procedure with significant hypotension (with systolic blood pressure ranging between 80 and 90 mmHg) and sinus tachycardia.[edmcasereports.com]
Skin Discoloration
  • Abstract 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]

Workup

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]
  • Investigations revealed anemia with thrombocytopenia, hyponatremia, and acute-on-chronic kidney injury. Despite treatment for urosepsis, she became tachypneic, clammy, light-headed, drowsy, and hypothermic.[ncbi.nlm.nih.gov]
  • Hydration and correction of the hyponatremia are necessary. Large doses of hydrocortisone, FIGURE 72-2.[mitchmedical.us]
  • 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]
Streptococcus Pneumoniae
  • Pre- or postmortem microbiological cultures were variably positive for Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus.[ncbi.nlm.nih.gov]
  • Pseudomonas aeruginosa can also cause WFS. [3] WFS can also be caused by Streptococcus pneumoniae infections, a common bacterial pathogen typically associated with meningitis in the adult and elderly population. [2] Mycobacterium tuberculosis could also[en.wikipedia.org]

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]
  • He received conservative treatment only.[ncbi.nlm.nih.gov]
  • The adrenal hemorrhage resolved within three months with glucocorticoid therapy, the cerebral venous thrombosis resolved within two months without treatment. The literature on neonatal cerebral venous thrombosis is also reviewed.[ncbi.nlm.nih.gov]
  • We present the case of a patient who came to the Emergency Department with unsuspected adrenal insufficiency, followed by a second visit within 1 month with shock, to demonstrate the importance of early detection and treatment.[ncbi.nlm.nih.gov]
  • Conservative treatment with clinical follow-up was adopted, with complete resolution within 10 days. The possible differential diagnoses are reviewed and discussed.[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

  • Abstract 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]
  • The antiphospholipid syndrome should be suspected in a patient presenting with adrenal crisis without a distinct etiology.[ncbi.nlm.nih.gov]
  • […] these well-recognized hypoxic lesions provide further evidence that certain developmental lung anomalies, such as focal acinar dysplasia, focal lobular hyperplasia, and microcystic maldevelopment, may, at least in some cases, have a hypoxic/ischemic etiology[ncbi.nlm.nih.gov]
  • Our objectives were to describe six cases from a single institution and to perform a literature review of the etiology of the condition and recommended management of patients with hemorrhagic adrenal masses.[ncbi.nlm.nih.gov]
  • DE The etiology, diagnosis and management of müllerian duct remnants are discussed. A complex case of penile- scrotal hypospadia, hypoplastic prostate gland, testicular ectopia and retrovesical cyst is presented.[linguatools.com]

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]
  • 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]
  • She received preemptive steroid therapy to prevent the occurrence of adrenal crisis, but 5 weeks later the replacement therapy was discontinued because the patient fully recovered with a normal adrenocorticotropic hormone stimulation test.[ncbi.nlm.nih.gov]
  • As such, it may be useful to recognize CT features of adrenal congestion as a sign for potential adrenal dysfunction and subsequent adrenal hemorrhage, so early steroid replacement therapy can be commenced to prevent death from adrenal insufficiency.[ncbi.nlm.nih.gov]
  • Serial USG is the best modality for monitoring AH to prevent unnecessary surgery.[ncbi.nlm.nih.gov]
  • The third case is described in this report; recovery of the patient prevented proof FULL TEXT[annals.org]

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