Adrenal hemorrhage and adrenal hematoma are conditions that affect the adrenal glands; they are most often treated without surgery. Endocrinologist Amir Hamrahian and endocrine surgeon Aarti Mathur explain the conditions and what to expect following a diagnosis of adrenal hemorrhage or hematoma.

What is an adrenal gland hemorrhage?

An adrenal hemorrhage is a condition in which blood vessels within the adrenal glands rupture. “The adrenal glands, located just above your kidneys, produce hormones that help regulate your blood pressure, immune system, response to stress and other essential functions,” Hamrahian explains. “Bleeding can interfere with the normal function of your adrenal glands, especially if it occurs at both glands. This may result in adrenal insufficiency.”

Adrenal hemorrhage is a life-threatening condition. If you or a loved one suspects adrenal hemorrhage, call 911 or seek medical care immediately.

What is an adrenal hematoma?

Adrenal hematoma describes an unruptured pool of blood, which often forms a blood clot in the adrenal gland that can mimic a tumor. Bleeding from one adrenal gland that eventually stops, known as an adrenal hematoma, can look like an adrenal tumor on imaging studies such as a CT scan.

Although adrenal hematoma is not common, it can mimic an adrenal tumor or may lead to shock and death unless recognized and treated appropriately.

Are adrenal hemorrhage and hematoma related?

Yes. Both conditions result in inappropriate bleeding in the adrenal gland, which can cause adrenal insufficiency, a life-threatening condition. Bleeding in the adrenal gland may begin as an adrenal hematoma and form a pocket of blood. If the hematoma ruptures, it is classified as an adrenal hemorrhage.

What are symptoms of adrenal hemorrhage and hematoma?

Symptoms of adrenal hemorrhage can vary, and some people with adrenal hematomas experience no symptoms. Most symptoms are due to adrenal insufficiency, and include:

• Pain (in the abdomen, or sides)
• Weakness
• Fatigue
• Dizziness
• Muscle aches
• Nausea and vomiting
• Low blood pressure
• Low blood sugar

If not treated, the adrenal hemorrhage may lead to:

• Extreme weakness
• Very low blood pressure
• Kidney failure
• Shock

How are adrenal hemorrhage and hematoma diagnosed?

Your health care provider will ask questions, review your medical history and perform a physical exam. Tests that can diagnose adrenal hemorrhage and consequent adrenal insufficiency include:

• Imaging tests: CT scan, MRI and ultrasound
• Blood tests

What causes adrenal hemorrhage and hematoma?

Adrenal hemorrhage and subsequent hematoma can be caused by:

• Trauma (motor vehicle accidents, falls, etc.)
• Severe infections
• Heart failure and heart attack
• Surgery (coronary artery bypass graft surgery, hip joint replacement, etc.)
• Complications of pregnancy
• Bleeding tendency (i.e., use of blood thinners, low blood platelets and vitamin K deficiency)
• Clotting disorders (antiphospholipid antibody syndrome)
• Adrenal gland tumors, including pheochromocytomas and cancer spread from other body organs to the adrenal glands
• Treatment with adrenocorticotropin hormone (ACTH)
• Liver transplantation
• Newborn birth injury
• COVID-19

How are adrenal hemorrhage and hematoma treated?

Your health care provider will decide the best treatment for you based on:

• Your age, overall health and health history
• Your adrenal gland’s function
• Your overall health
• How well you can handle certain medicines, procedures or therapies
• How long the condition is expected to last
• Your opinion or preference

Treatment may include hormones to replace those your adrenal glands are not making, most commonly cortisol. Treatment often starts with intravenous (IV) fluids and a medication called hydrocortisone. You may take this medication by mouth or by IV. In emergent situations, treatment might also include transfusion of blood products. It is important to urgently treat underlying condition(s) as well.

Surgery

In traumatic adrenal hemorrhage, emergency embolization — a minimally invasive procedure performed by an interventional radiologist to control the bleeding — may be required.

“When a hematoma cannot be clearly diagnosed, looks like a tumor or produces high levels of hormones, particularly adrenaline or cortisol, surgery may be needed,” explains Mathur. This is performed to control the bleeding and regulate hormones within the body. Mathur adds, “If the hematoma is quite large and is continuing to grow, the adrenal gland may need to be removed in a procedure called an adrenalectomy.”

Living with adrenal hemorrhage/hematoma

If you are diagnosed with adrenal insufficiency following adrenal hemorrhage, it is important to follow your doctor’s guidance. If you become sick, contact your health care provider.

Additionally, to maintain your health, be sure to:

• Take your medicines exactly as they are prescribed, including doubling dosages when you are sick.
• Always wear an appropriate identification tag or bracelet.
• Carry an emergency kit when traveling, including prescribed medications.

You may experience salt cravings. If you’re craving salt, your blood pressure may be low. Having too little salt in your diet is not good for you. If you have a history of high blood pressure, heart failure or kidney failure, consult with your health care provider about your amount of daily salt intake.

When should I call my health care provider?

If you have adrenal insufficiency, any condition that stresses your body can affect the dosage of medication you need. Call your health care provider if:

• You have any kind of illness, especially a fever, vomiting or diarrhea
• You become pregnant
• You need surgery

Get medical help right away if you have sudden severe symptoms.

Dr. Roshan Dinparastisaleh, 2021 Endocrinology Research Fellow, prepared this article under the supervision of Dr. Hamrahian, Salvatori and Morris-Wiseman.