Unilateral or bilateral with segmental or diffuse involvement of adrenal gland.
Traumatic (usually unilateral) or atraumatic.
Bilateral adrenal hemorrhage can result to a catastrophic adrenal gland failure.
Risk factors include shock or sepsis (meningococcemia), DIC, anticoagulation, steroid use or adrenal neoplasm.
Adrenal gland is enlarged with hemorrhage and necrosis in both cortex and medulla (image A) & (image B).
Waterhouse-Friderichsen syndrome is an acute bilateral massive adrenal hemorrhage mostly in pediatric patients, most commonly secondary to meningococcal or pseudomonal septicemia (consequence rather than cause of shock).