Q: What is the basis of underlying patho-physiology of adrenal hemorrhage in ICU patients?

Answer: Arterial supply of adrenal gland is high but it relies on only one vein for drainage. During stress as occurs in many critical care patients, there is a rise in ACTH secretion, which stimulates the adrenal arterial blood flow but venous capacity may remain limited and may lead to adrenal hemorrhage. And, the situation may get worse if a patient is on anticoagulation. Superimposed factors in the stressful situation are adrenal vein spasm induced by pressors or high catecholamine levels or adrenal vein thrombosis induced by disseminated intravascular coagulation (DIC).