American Urological Association - Adrenal Hemorrhage
- Unilateral or bilateral with segmental or diffuse involvement of adrenal gland.
- Traumatic (usually unilateral) or atraumatic.
- Bilateral adrenal hemorrhage can result to a catastrophic adrenal gland failure.
- Risk factors include shock or sepsis (meningococcemia), DIC, anticoagulation, steroid use or adrenal neoplasm.
- Adrenal gland is enlarged with hemorrhage and necrosis in both cortex and medulla (image A) & (image B).
- Waterhouse-Friderichsen syndrome is an acute bilateral massive adrenal hemorrhage mostly in pediatric patients, most commonly secondary to meningococcal or pseudomonal septicemia (consequence rather than cause of shock).