An Unusual Cause of Abdominal Pain
A 69 yo M with pmhx of HTN, atrial fibrillation on warfarin, unspecified hx of thyroid and parathyroid cancers status post resection presents with acute left-sided abdominal pain. Subsequent labs showed a significant drop in hematocrit and imaging showed a large left-sided adrenal hemorrhage. The patient had his anti-coagulation reversed, then was taken to IR-suite for embolization of a sub-branch of his left adrenal artery.
Adrenal hemorrhage is an uncommon condition. When there is significant stress, the adrenal gland becomes edematous and prone to hemorrhage. Epinephrine is a potent thrombogenic factor and with adrenal edema, blood flow can slow leading to adrenal vein thrombosis and hemorrhage.
It is thought with several factors that can predispose:
- Sepsis and severe illness
- Post-operative period
- Coagulopathy
- Thrombotic Disorders (special attention to Anti-Phospholipid Antibody Syndrome)
- Adrenal masses
- Systemic Steroid Use
Please read this great review from the Mayo Clinic Proceedings about adrenal hemorrhage:
- Mayo Clinic ProceedingsFebruary 2001 vol. 76 no. 2 161-168 – Adrenal Hemorrhage: A 25-year Experience at the Mayo Clinic