Suprarenal gland hemorrhage: A bleeding manifestation that may be caused by thrombosis of efferent veins

Suprarenal gland hemorrhage has been described in several conditions (sepsis, local traumas, surgical procedures, anticoagulant therapies, ACTH administration, protracted stress, hypoxemia).The condition is rare in congenital bleeding disorders.Recently, two new morbid conditions, namely Heparin induced thrombocytopenia and Antiphosfolipids Antibodies Syndrome have been reported as frequent causes of suprarenal gland bleeding.The condition may be classified as monolateral or bilateral.The first is usually paucisymptomatic, the latter, severely symptomatic.The causative mechanisms are two, namely 1) direct congestion and damage of the gland with secondary leakage of blood and consequent cell destruction and 2) thrombosis of efferent veins with consequent upstream increased pressure and rupture of vessels.The first mechanism, direct cellular insult is typical of most of the old cases.On the contrary, the thrombotic occlusion of efferent veins is typical of the new morbid conditions, namely Heparin induced thrombocytopenia, Antiphospholipids Antibodies Syndrome and Polycythemia vera.This second mechanism could be envisaged as an example of thrombo-hemorrhagic disorder.An idiopathic form has also been described.The variety and complexity of causes have great implications in diagnostic procedures, therapeutic approaches and outcomes.