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文献考察：副腎出血
Radiographics. 1999 Jul-Aug;19(4):949-63.
Imaging of nontraumatic hemorrhage of the adrenal gland.
Kawashima A, Sandler CM, Ernst RD, Takahashi N, Roubidoux MA, Goldman SM, Fishman EK, Dunnick NR.
Nontraumatic hemorrhage of the adrenal gland is uncommon. The causes of such hemorrhage can be classified into five categories: (a) stress, (b) hemorrhagic diathesis or coagulopathy, (c) neonatal stress, (d) underlying adrenal tumors, and (e) idiopathic disease. Computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging play an important role in diagnosis and management. CT is the modality of choice for evaluation of adrenal hemorrhage in a patient with a history of stress or a hemorrhagic diathesis or coagulopathy (anticoagulant therapy). CT may yield the first clue to the diagnosis of adrenal insufficiency secondary to bilateral massive adrenal hemorrhage; such insufficiency is rare but life threatening. US is the modality of choice for evaluation of neonatal hematoma, and MR imaging is helpful for further characterization. MR imaging is also useful in the diagnosis of coexistent renal vein thrombosis. When an adrenal abscess is suspected, percutaneous aspiration and drainage under imaging guidance should be performed. Hemorrhage into an adrenal cyst or tumor can cause acute onset of symptoms and signs in a patient without discernible risk factors for adrenal hemorrhage. A hemorrhagic adrenal tumor should be suspected when CT or MR imaging reveals a hemorrhagic adrenal mass of heterogeneous attenuation or signal intensity that demonstrates enhancement. PMID: 10464802
Causes of Nontraumatic Adrenal Hemorrhage
Stress * ▲
Surgery
Sepsis
Burns
Hypotension
Pregnancy
Cardiovascular disease
Exogenous adrenocorticotropic hormone
Exogenous steroids
Hemorrhagic diathesis or coagulopathy (idiopathic or iatrogenic)* ▲
Anticoagulants (heparin, coumarin)
Antiphospholipid syndrome with or without systemic lupus erythematosus
Disseminated intravascular coaguｌopathy
Neonatal stress*
Difficult labor or delivery
Asphyxia or hypoxia
Septicemia
Hemorrhagic disorders (e.g., disseminated intravascular coagulopathy, hypoprothrombinemia)
Extracorporeal membrane oxygenation
Associated renal vein thrombosis
Underlying adrenal tumors
Pseudocyst
Myelolipoma
Hemangioma
Pheochromocytoma*
Adrenocortical adenoma
Adrenocortical carcinoma
Metastases (bronchogenic carcinoma, angiosarcoma, melanoma)*
Idiopathic disease
* causes of bilateral adrenal hemorrhage.
▲ ｃauses of adrenal insufficiency secondary to bilateral adrenal hemorrhage.
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