Spontaneous idiopathic bilateral adrenal haemorrhage: a rare cause of abdominal pain

Nazir, Salik; Sivarajah, Surendra; Fiscus, Valena; York, Eugene

doi:10.1136/bcr-2016-215452

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…Spontaneous adrenal haemorrhage has been defined variably in the literature. Some authors refer to this as the absence of trauma or anti-coagulant use while others restrict its use to cases where there is no obvious predisposition other than adrenal pathology (19,20). Bleeding in the absence of any adrenal pathology (i.e., normal adrenals on imaging after resolution of bleeding) and without other predisposing factors is thought to be very rare.…”

Section: Original Articlementioning

confidence: 99%

Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

Ali¹,

Singh²,

Balasubramanian³

2018

Gland Surg

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Background: Acute adrenal haemorrhage is a rare medical emergency. The aim of the series was to study the clinical presentation and management of patients presenting with acute non-traumatic adrenal haemorrhage. Methods: The records of patients presenting with an acute abdomen secondary to adrenal haemorrhage and treated in a tertiary endocrine surgical unit over a period of 6 years were reviewed. Results: Of the 11 included patients, there were 4 males and 7 females; the median [range] age at presentation was 58 [27-89] years. All were initially managed conservatively for bleeding, except one who underwent angioembolisation to ensure hemodynamic stability. Two patients underwent percutaneous drainage of persistent collection and suspected sepsis. Biochemical workup showed hyper function with metanephrine excess in 1 patient. Adrenalectomy was performed in 5 patients after a median [range] of 10 [7-11] weeks. Histology showed benign pathology in 2 patients, malignant in 2 patients and necrotic tumour in 1 patient. Two patients died of disseminated metastatic disease at 5 and 2 months after presentation with bleeding. Conservative management in the other 3 patients was successful at a median follow up of 26 [6-66] months. Conclusions: Acute adrenal haemorrhage is usually associated with an underlying pathology; which may be benign or malignant; functional or non-functional. Initial conservative management is preferred as it allows determination of functional status and elective surgery, if necessary.

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Section: Original Articlementioning

confidence: 99%

Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

Ali¹,

Singh²,

Balasubramanian³

2018

Gland Surg

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“…Notably, adrenal insufficiency symptoms may not manifest unless approximately 90% of adrenal function is compromised [ 5 ]. The exact pathophysiology of adrenal hemorrhage remains a subject of ongoing research [ 6 ]. Understanding the anatomy of the adrenal gland is crucial to grasp this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

“…While it receives a rich arterial blood supply, it has limited venous drainage, leading to vascular congestion. Proposed mechanisms include the development of a prothrombotic state, with malignancies causing thrombosis in adrenal veins, elevating vascular pressure, and causing hemorrhage [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Adrenal Hemorrhage Heralds Bronchogenic Carcinoma

Azani,

Alozai,

William

et al. 2024

Cureus

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This case study delves into the unusual presentation of non-small cell lung carcinoma (NSCLC), where bilateral hemorrhagic adrenal metastasis served as the primary indication of an underlying malignancy. Our patient, a 58-year-old male, sought medical attention due to acute abdominal pain and lower back discomfort, leading to an in-depth diagnostic exploration. Radiological examinations revealed bilateral adrenal masses exhibiting hemorrhagic characteristics, a distinctive feature not commonly associated with NSCLC. The subsequent biopsy and histopathological analysis definitively identified metastatic NSCLC as the culprit. The uniqueness of this case lies in the bilateral nature of the metastasis and the presence of hemorrhagic elements, challenging traditional diagnostic expectations. This report emphasizes the necessity for a nuanced approach to diagnostic investigations when confronted with atypical presentations, especially considering the rarity of bilateral involvement and hemorrhagic features in adrenal metastases from NSCLC. It highlights the importance of interdisciplinary collaboration between radiologists, pathologists, and oncologists to ensure accurate and timely diagnosis. The overarching significance of this case extends beyond its rarity; it underscores the imperative for healthcare practitioners to broaden their diagnostic considerations in the absence of conventional symptoms. By presenting this distinctive case, we contribute to the evolving understanding of the diverse clinical manifestations of NSCLC, advocating for heightened vigilance and comprehensive diagnostic approaches in the pursuit of early intervention and optimal patient care.

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Methylprednisolone

2017

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Spontaneous idiopathic bilateral adrenal haemorrhage: a rare cause of abdominal pain

Cited by 4 publications

References 17 publications

Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

Bilateral Adrenal Hemorrhage Heralds Bronchogenic Carcinoma

Methylprednisolone

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