Adrenal haemorrhage

Bilateral adrenal haemorrhage, when not due to trauma, is most frequently been attributed to adrenal vein spasm or thrombosis. Predisposing risk factors include:

1. sepsis, esp menigoccocaemia (aka Waterhouse-Friedrickson syndrome)
2. DIC
3. primary antiphospholipid syndrome
4. heparin-induced thrombocytopaenia

Bilateral haemorrhage usually results in an adrenal crisis, with coma and death resulting if replacement steroid therapy is not administered promptly. Despite treatment, overall there is approximately a 15% mortality, and about 50% when in the setting of sepsis.