Deteriorating condition of bleeding and necrosis of all 3 cortical layers of the bilateral adrenal glands, possibly in combination with adrenal infarction and adrenal vein thrombosis. It can cause a life-threatening acute adrenal crisis characterized by hypotension, shock, and death if not immediately treated. Symptoms include pain (lumbar, epigastric, pelvic, flank, and thoracic), fatigue, fever, epigastric findings (nausea, vomiting, loss of appetite), and neurologic findings (disorientation, confusion). Risk factors for adrenal hemorrhage include anticoagulant therapy, heparin-induced thrombocytopenia, trauma, sepsis, severe stress, postoperative state, and adverse drug reactions.

Treatment may include preemptive steroid therapy, resolving acute crisis, rehydration, and bed rest. Surgery is only recommended when severe adrenal trauma or tumors are involved.