Endocrine System

Adrenal Gland - Hemorrhage

Narrative
Comment:
Adrenal gland hemorrhage (Figure 1, Figure 2, Figure 3, and Figure 4) is characterized by the presence of variable amounts of extravasated blood cells in the cortex and/or medulla. Hemorrhage can be focal or diffuse and range in severity from a small focal area to extensive involvement that can distort or even obliterate normal architecture (Figure 1, Figure 2, Figure 3, and Figure 4).

Adrenal hemorrhage can be secondary to many spontaneous or treatment-related pathologic processes such as primary vascular disease, systemic coagulopathy, infarction, and septicemia. Many chemicals, as well as very high doses of exogenous adrenocorticotropic hormone (ACTH), are known to cause adrenal hemorrhage (primarily in the cortex), often in association with necrosis.
Recommendations:
Adrenal hemorrhage should be diagnosed and assigned a severity grade, site modifier (i.e., cortex, medulla), and distribution modifier (i.e., focal, diffuse). If it is present in both the cortex and medulla, the site modifier may be omitted and the location described in the pathology narrative. Hemorrhage secondary to other lesions (e.g., cystic degeneration, inflammation, or necrosis) should not be diagnosed separately, unless warranted by severity, but may be described in the pathology narrative.
References:

Braun AG. 1990. Survival, Age-Associated Disease and Neoplasia of the B6C3F1 Mouse: Lifespan Phase. MRI-NTP 52-89-145. TSI Mason Research Institute, Worcester, MA.

Burkhardt WA, Guscetti F, Boretti FS, Todesco AI, Aldajarov N, Lutz TA, Reusch CE, Sieber-Ruckstuhl NS. 2011. Adrenocorticotropic hormone, but not trilostane, causes severe adrenal hemorrhage, vacuolization, and apoptosis in rats. Dom Anim Endocrinol 40:155-164.

Abstract: https://www.ncbi.nlm.nih.gov/pubmed/21194873

Hamlin MH, Banas DA. 1990. Adrenal gland. In: Pathology of the Fischer Rat: Reference and Atlas (Boorman GA, Eustis SL, Elwell MR, Montgomery CA, MacKenzie WF, eds). Academic Press, San Diego, 501-518.

Abstract: https://www.ncbi.nlm.nih.gov/nlmcatalog/9002563

National Toxicology Program. 2012. NTP TR-571. Toxicology and Carcinogenesis Studies of Kava Kava Extract (CAS No. 9000-38-8) in F344/N Rats and B6C3F1 Mice (Gavage Studies). NTP, Research Triangle Park, NC.

Abstract: https://ntp.niehs.nih.gov/go/36127

Nyska A, Maronpot RR. 1990. Adrenal gland. In: Pathology of the Mouse: Reference and Atlas (Maronpot RR, Boorman GA, Gaul BW, eds). Cache River Press, Vienna, IL, 509-536.

Abstract: http://www.cacheriverpress.com/books/pathmouse.htm

Szabo S, Lippe IT. 1989. Adrenal gland: Chemically induced structural and functional changes in the adrenal cortex. Toxicol Pathol 17:317-329.

Abstract: https://www.ncbi.nlm.nih.gov/pubmed/2675282
  • Image of hemorrhage in the adrenal gland from a female F344/N rat in a chronic study

    Adrenal gland - Hemorrhage in a female F344/N rat from a chronic study (higher magnification of Figure 1). Extensive, diffuse hemorrhage is present in the cortex.

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Adrenal gland - Hemorrhage in a female F344/N rat from a chronic study. Extensive, diffuse hemorrhage (Hem) is present in the cortex and medulla.
Adrenal gland - Hemorrhage in a female F344/N rat from a chronic study. Extensive, diffuse hemorrhage (Hem) is present in the cortex and medulla.
Adrenal gland - Hemorrhage in a female F344/N rat from a chronic study (higher magnification of Figure 1). Extensive, diffuse hemorrhage is present in the cortex.
Adrenal gland - Hemorrhage in a female F344/N rat from a chronic study (higher magnification of Figure 1). Extensive, diffuse hemorrhage is present in the cortex.
Adrenal gland, Cortex - Hemorrhage in a male B6C3F1/N mouse from a chronic study. Extensive, diffuse hemorrhage replaces much normal cortex.
Adrenal gland, Cortex - Hemorrhage in a male B6C3F1/N mouse from a chronic study. Extensive, diffuse hemorrhage replaces much normal cortex.
Adrenal gland, Cortex - Hemorrhage in a male B6C3F1/N mouse from a chronic study (higher magnification of Figure 3). Extensive, diffuse cortical hemorrhage almost obliterates the normal cortical architecture.
Adrenal gland, Cortex - Hemorrhage in a male B6C3F1/N mouse from a chronic study (higher magnification of Figure 3). Extensive, diffuse cortical hemorrhage almost obliterates the normal cortical architecture.

Authors

Mark J. Hoenerhoff, DVM, PhD, DACVP
Associate Professor
Veterinary Pathologist, In Vivo Animal Core
Unit for Laboratory Animal Medicine
University of Michigan
Ann Arbor, MI

Georgette D. Hill, D.V.M., Ph.D.
Toxicologic Pathologist/Assistant Pathology Program Manager
Comparative Molecular Pathology Division
Integrated Laboratory Systems, Inc.
Research Triangle Park, NC

Margarita M. Gruebbel, DVM, PhD, DACVP
Senior Pathologist
Experimental Pathology Laboratories, Inc.
Research Triangle Park, NC

Reviewers

Thomas J. Rosol, DVM, PhD, DACVP
Professor of Veterinary Biosciences
Senior Advisor, Life Sciences, Technology Commercialization and Knowledge Transfer
The Ohio State University
Columbus, OH

Gordon Flake, MD
Staff Scientist
NTP Pathologist
Cellular and Molecular Pathology Branch
National Institute of Environmental Health Sciences
Research Triangle Park, NC