{
    "abstract": "Although uncommon, adrenal hemorrhage has multiple etiologies. Because clinical characteristics, management, and outcomes of patients with adrenal hemorrhage are inadequately described, we examined the underlying etiology, need for intervention, evolution of imaging characteristics, and adequacy of subsequent evaluation.\nWe performed a retrospective review of patients diagnosed with adrenal hemorrhage (radiologist-confirmed density consistent with hemorrhage on computed tomography) from 2005 to 2021 at a university-based institution. Demographic characteristics, hemorrhage etiology, and subsequent follow-up were analyzed.\nOf 193 adrenal hemorrhage patients, the mean age was 49.2 \u00b1 18.3 years, and 35% were female. Clinical presentations included trauma (47%), abdominal or flank pain (28%), incidental findings on imaging acquired for other reasons (12%), postoperative complication (8%), or shock (3%). Hemorrhage outside of the gland was present in 62% of patients. Unilateral hemorrhage was more frequent (93%) than bilateral (7%). A total of 12% of patients had nodules, but only 70% of these were identified on initial imaging, and only 43% had hormonal evaluation. Of 7 patients who had adrenalectomy or biopsy, pathology was either benign (57%) or nonadrenal malignancy (43%). No adrenocortical carcinomas were identified. Follow-up imaging was performed in 56% of patients and revealed decreased, stable, resolved, or increased adrenal hemorrhage size in 39%, 19%, 30%, and 12% of patients, respectively.\nAdrenal hemorrhage is secondary to multiple etiologies, most commonly trauma. In the setting of adrenal hemorrhage, many adrenal nodules were not identified on initial imaging. Only a minority of patients with nodules underwent \"complete\" biochemical evaluation. Follow-up imaging may improve the identification of underlying nodules needing hormonal evaluation.",
    "authors": [
        {
            "affiliation": "Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: https://www.twitter.com/turayza.",
            "firstname": "Theresa N",
            "initials": "TN",
            "lastname": "Wang"
        },
        {
            "affiliation": "Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: https://www.twitter.com/vennilapadmanMD.",
            "firstname": "Vennila",
            "initials": "V",
            "lastname": "Padmanaban"
        },
        {
            "affiliation": "Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA.",
            "firstname": "Elizabeth J",
            "initials": "EJ",
            "lastname": "Bashian"
        },
        {
            "affiliation": "Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH.",
            "firstname": "Harold W",
            "initials": "HW",
            "lastname": "Davis"
        },
        {
            "affiliation": "Department of Surgery, University of Colorado, Aurora, CO. Electronic address: https://www.twitter.com/MichaelJKirsch.",
            "firstname": "Michael J",
            "initials": "MJ",
            "lastname": "Kirsch"
        },
        {
            "affiliation": "Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: https://www.twitter.com/JohnPhayMD.",
            "firstname": "John E",
            "initials": "JE",
            "lastname": "Phay"
        },
        {
            "affiliation": "Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: https://www.twitter.com/OSUEndoSurgBSM.",
            "firstname": "Barbra S",
            "initials": "BS",
            "lastname": "Miller"
        },
        {
            "affiliation": "Department of Radiology, The Ohio State University, Columbus, OH.",
            "firstname": "Caitlin E",
            "initials": "CE",
            "lastname": "Hackett"
        },
        {
            "affiliation": "Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: priya.dedhia@osumc.edu.",
            "firstname": "Priya H",
            "initials": "PH",
            "lastname": "Dedhia"
        }
    ],
    "conclusions": "Adrenal hemorrhage is secondary to multiple etiologies, most commonly trauma. In the setting of adrenal hemorrhage, many adrenal nodules were not identified on initial imaging. Only a minority of patients with nodules underwent \"complete\" biochemical evaluation. Follow-up imaging may improve the identification of underlying nodules needing hormonal evaluation.",
    "copyrights": "Copyright \u00a9 2024 The Author(s). Published by Elsevier Inc. All rights reserved.",
    "doi": "10.1016/j.surg.2024.03.004",
    "journal": "Surgery",
    "keywords": [],
    "methods": null,
    "publication_date": "2024-04-10",
    "pubmed_id": "38594100",
    "results": "Of 193 adrenal hemorrhage patients, the mean age was 49.2 \u00b1 18.3 years, and 35% were female. Clinical presentations included trauma (47%), abdominal or flank pain (28%), incidental findings on imaging acquired for other reasons (12%), postoperative complication (8%), or shock (3%). Hemorrhage outside of the gland was present in 62% of patients. Unilateral hemorrhage was more frequent (93%) than bilateral (7%). A total of 12% of patients had nodules, but only 70% of these were identified on initial imaging, and only 43% had hormonal evaluation. Of 7 patients who had adrenalectomy or biopsy, pathology was either benign (57%) or nonadrenal malignancy (43%). No adrenocortical carcinomas were identified. Follow-up imaging was performed in 56% of patients and revealed decreased, stable, resolved, or increased adrenal hemorrhage size in 39%, 19%, 30%, and 12% of patients, respectively.",
    "title": "Clinical characteristics and outcomes of adrenal hemorrhage.",
    "xml": "<Element 'PubmedArticle' at 0x788504e3e200>"
}