Adrenal glands are two tiny glands. Each of them lies on the upper pole of kidney. The gland consists of two layers, the inner medulla which secretes adrenaline and noradrenaline hormone. The outer cortex secretes cortisol, aldosterone and many other hormones. Though a tiny structure, adrenal gland is very important organ in the body. The hormones which it produces play a valuable role in human body.
Adrenal hemorrhage is rare, but when it occurs, it can lead to shock, adrenal crisis and death. Recognizing the emergency situation and treating it promptly is important to save the life in adrenal hemorrhage.
Adrenal hemorrhage can lead to adrenal insufficiency or adrenal crisis, especially when there is hemorrhage in both the adrenal glands. The condition in most cases is fatal unless it is recognized and treated promptly. Hemorrhage from one adrenal gland has less fatality ratio.
Adrenal hemorrhage is common in males as compared to females. In non traumatic cases adrenal hemorrhage occurs between 40 to 80 years, while traumatic adrenal hemorrhage is most often observed in younger people.
Signs And Symptoms Of Adrenal Hemorrhage
There are no classical symptoms that may help to diagnose adrenal hemorrhage. They are nonspecific.They mimic symptoms similar to many other conditions. Therefore wrong diagnosis may cost the patient his life.
- Patient complains of pain in abdomen, back, in upper chest and in pelvic area. Other symptoms of underlying disease are also present. It is very rare to find adrenal hemorrhage without any symptoms, and incidental detection only on sonogram and CT scan.
- Patient may complain of pain in left shoulder accompanied with pain in abdomen. This is due to irritation of the diaphragm; membrane which separates abdomen and chest.
- Other symptoms include low blood pressure, weakness, fatigue, joints pains, muscle pains. 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.
- Pigmentation of skin and mucus membrane of mouth, and conjunctiva are present together with weight loss in sub acute cases.
- 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.
- Infection: Infections of wound, pneumonia, influenza, malaria, colitis are few of them.
- Diseases such as pancreatitis, myocardial infarction, congestive heart failure, and cirrhosis of liver are responsible for adrenal hemorrhage.
- Waterhouse friderichsen syndrome is a condition where there is hemorrhagic necrosis of several body organs. It also includes adrenal gland.
- Complication of pregnancy such as toxemia, antepartum and postpartum hemorrhage can also occur but in rare instances.
- Adrenal hemorrhage has been observed after major surgery such as that of coronary bypass, hip replacement, brain surgery etc.
- Use of anticoagulants especially in people who have hemorrhagic tendency.
- Deep vein thrombosis, pulmonary embolism, cerebrovascular disease.
- Blunt injury due to road accidents, rough ride on a bumpy road.
- Accidental injury while doing an open abdominal operation, penetration of sharp instrument in abdomen and injuring the adrenal gland.
- Patient taking treatment with ACTH hormone for multiple sclerosis is sometimes associated with adrenal hemorrhage.
Adrenal Hemorrhage Treatment
- If the patient is suspected of having adrenal hemorrhage he should be immediately admitted in the hospital for further evaluation. This is because acute adrenal crisis may develop any time in these patients.
- However, most of the time the patient having adrenal hemorrhage is found to be sick and already in the hospital for other reasons.
- If the patient present with a mass in abdomen, he should be evaluated with several available tests such as sonogram, CT scan etc.
- 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.
- If the cause for adrenal hemorrhage is not traumatic, surgery is generally not required.
- Patient having adrenal tumor with adrenal hemorrhage may require surgery.
- In traumatic injury, surgery may be required to control bleeding, for exploring penetrating wound.