Adrenal hemorrhage: A 25-year experience at the Mayo Clinic

Objective: To characterize the clinical course of adrenal hemorrhage (AH) b y using a systematic review of the presentation, associated conditions, and outcomes in patients with AII seen at our institution between 1972 and 199 7 (a 25-year period). Patients and Methods: A computer search of recorded dismissal diagnoses ide ntified 204 patients with a diagnosis of AN, but only 141 fulfilled our stu dy criteria. Their records were analyzed systematically by presentation, bi lateral or unilateral hemorrhage, corticosteroid treatment, and survival. Results: AH is a heterogeneous entity that occurs in the postoperative peri od, in the antiphospholipid-antibody syndrome, in heparin-associated thromb ocytopenia, or in the setting of se, ere physical stress and multiorgan fai lure, Standard laboratory evaluation is not helpful in establishing the dia gnosis. Of the 141 cases of AH, 78 were bilateral, and 63 were unilateral. Corticosteroid treatment in situations of severe stress or sepsis had littl e effect on outcome (9% vs 6% survival with and without corticosteroid trea tment, respectively). This is in sharp contrast to AH occurring postoperati vely (100% vs 17% survival with or without treatment, respectively) or in t he antiphospholipid-antibody syndrome (73% vs 0% survival, respectively). Conclusions: A high index: of suspicion is required to make a timely diagno sis of AB, Fever and hypotension in the appropriate clinical setting necess itate further investigation. Although the diagnosis of AN is infrequently m ade while the patient is alive, appropriate imaging techniques are useful f or establishing a timely diagnosis, In severe physical stress or sepsis, AH may be a marker of severe, preterminal physiologic stress and poor outcome .