Adrenal Hemorrhage
Bleeding into the adrenal glands that can trigger an adrenal crisis
Quick Facts
- Type: Endocrine and vascular emergency
- Common triggers: Severe infection, trauma, blood thinners, surgery
- Glands affected: One or both adrenal glands
- Seek urgent care: Sudden flank/abdominal pain, collapse, very low blood pressure
Overview
The adrenal glands are two small glands that sit on top of the kidneys and make hormones such as cortisol and aldosterone that help control blood pressure, blood sugar, and the body's response to stress. Adrenal hemorrhage means bleeding has occurred inside one or both of these glands.
When only one gland is affected, there may be few or no lasting effects because the other gland can compensate. When both glands bleed (bilateral adrenal hemorrhage), the glands may suddenly stop making enough cortisol, leading to a dangerous condition called acute adrenal insufficiency or adrenal crisis. This can be life-threatening and requires emergency treatment.
Symptoms
Symptoms can come on quickly and are sometimes mistaken for other abdominal or infectious illnesses. They may include:
- Sudden pain in the flank, back, or upper abdomen
- Nausea, vomiting, or loss of appetite
- Weakness, extreme tiredness, and confusion
- Fever, especially when infection is the trigger
- Low blood pressure, dizziness, or fainting
When both glands are involved, signs of adrenal crisis may appear: very low blood pressure, collapse, severe weakness, abdominal pain, and shock. These are emergencies that need immediate medical care.
Causes
Adrenal hemorrhage happens when small blood vessels within the gland are damaged or overwhelmed. Common situations that lead to it include:
- Severe infection (sepsis): Overwhelming bacterial infection, including meningococcal infection, can cause bleeding into both glands.
- Blood thinners and clotting problems: Anticoagulant medicines or bleeding and clotting disorders raise the risk.
- Trauma: A direct injury to the abdomen or back, or major surgery.
- Physical stress: Serious illness, heart attack, or complicated childbirth.
- Newborns: Difficult deliveries can cause adrenal bleeding in babies.
Risk Factors
- Use of anticoagulant (blood-thinning) medication
- Severe infection or sepsis, including in critically ill hospital patients
- Blood clotting or bleeding disorders, including antiphospholipid syndrome
- Recent major surgery or significant trauma
- Complicated pregnancy or delivery
- Newborn period, especially after a difficult birth
Diagnosis
Because symptoms are nonspecific, diagnosis often relies on imaging in a person who is seriously ill. Tests may include:
- CT or MRI scan: Imaging of the abdomen is the most reliable way to see bleeding in the adrenal glands.
- Ultrasound: Often used first in newborns and infants.
- Blood tests: Cortisol and ACTH levels help confirm adrenal insufficiency; sodium, potassium, and blood sugar are also checked.
Doctors may suspect adrenal hemorrhage in any critically ill person who develops unexplained low blood pressure and abdominal pain.
Treatment
Treatment focuses on supporting the body and replacing missing adrenal hormones when needed.
- Steroid replacement: If the glands cannot make enough cortisol, intravenous hydrocortisone is given urgently and may be continued long term.
- Fluids and supportive care: Intravenous fluids help correct low blood pressure and dehydration.
- Treating the cause: Antibiotics for infection, careful management of blood thinners, and treatment of any clotting disorder.
Adrenal crisis is a medical emergency. People who have had adrenal hemorrhage affecting both glands often need lifelong hormone replacement and should carry information about their condition.
Prevention
- Take blood thinners exactly as prescribed and attend recommended monitoring
- Seek prompt treatment for serious infections
- Tell health professionals about any bleeding or clotting disorder before surgery
- If you have known adrenal insufficiency, follow your steroid sick-day plan and carry an emergency steroid card
When to See a Doctor
Seek emergency care immediately if you or someone else has:
- Sudden severe pain in the flank, back, or abdomen with weakness or fainting
- Very low blood pressure, collapse, or confusion
- High fever with rapid deterioration, especially with a spreading rash
If you have known adrenal insufficiency and feel very unwell, vomit repeatedly, or cannot keep medication down, treat it as an emergency and seek care right away.
Frequently Asked Questions
Is adrenal hemorrhage an emergency?
It can be. Bleeding in one gland may cause few problems, but bleeding in both glands can stop cortisol production and cause adrenal crisis, which is life-threatening. Sudden severe abdominal or flank pain with weakness, fainting, or very low blood pressure needs emergency care.
What causes bleeding in the adrenal glands?
Common causes include severe infection or sepsis, blood-thinning medication, clotting disorders, trauma, major surgery, and complicated childbirth. In newborns it can follow a difficult delivery. Often more than one factor is involved at the same time.
How is adrenal hemorrhage diagnosed?
A CT or MRI scan of the abdomen is the most reliable way to see the bleeding, while ultrasound is often used in babies. Blood tests for cortisol and related hormones show whether the glands are still working, and electrolytes and blood sugar are also checked.
Will I need treatment for life?
If the bleeding permanently damages both glands, you may need lifelong steroid hormone replacement to replace the cortisol your body can no longer make. People in this situation usually carry an emergency steroid card and learn a sick-day plan to prevent crisis.
Can the adrenal glands recover after bleeding?
Sometimes. If only one gland is affected or the damage is partial, function may return over weeks to months. Recovery is followed with repeat blood tests, and steroid replacement is adjusted or stopped only under medical guidance.
References
- MedlinePlus, U.S. National Library of Medicine. Adrenal gland disorders.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Adrenal Insufficiency & Addison's Disease.
- Mayo Clinic. Addison's disease — Symptoms and causes.