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Pathology for Urologists

Adrenal Hemorrhage

Image A
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Image B
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  • 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).

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