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: