Hemorrhagic stroke represents a significant cause of mortality worldwide, often accompanied by complex systemic pathophysiological changes. The adrenal glands, being highly vascularized organs crucial for stress response, may undergo specific pathomorphological alterations in patients with fatal hemorrhagic stroke. To investigate the pathomorphological changes in adrenal glands of patients who died from hemorrhagic stroke and analyze their relationship with clinical outcomes and mortality patterns. A retrospective autopsy study was conducted on 156 patients who died from hemorrhagic stroke between January 2020 and December 2023. Adrenal glands were systematically examined using histopathological analysis, immunohistochemistry, and morphometric evaluation. Clinical data including stroke severity, duration of illness, and comorbidities were correlated with pathological findings. Adrenal pathological changes were identified in 89.7% (140/156) of cases. Hemorrhagic changes were present in 62.8% of patients, with bilateral involvement in 23.1% of cases. Cortical necrosis was observed in 45.5% of patients, predominantly affecting the zona fasciculata. Medullary changes including chromaffin cell depletion were noted in 71.2% of cases. These changes appear to be related to the severity of cerebral injury and systemic complications, potentially contributing to the fatal outcome through impaired stress response mechanisms.

hemorrhagic stroke, adrenal glands, pathomorphology, autopsy, cortical necrosis, adrenal hemorrhage

Adeoye O, Sucharew H, Khoury J, et al. Recombinant factor VIIa in intracerebral hemorrhage: analysis of the Virtual International Stroke Trials Archive. Stroke. 2015;46(3):692-695.

Al-Shahi Salman R, Frantzias J, Lee RJ, et al. Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review. PLoS One. 2018;13(9):e0204702.

Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368(25):2355-2365.

Arima H, Huang Y, Wang JG, et al. Earlier blood pressure-lowering and greater attenuation of hematoma growth in acute intracerebral hemorrhage: INTERACT2. Stroke. 2012;43(8):2236-2238.

Baharoglu MI, Cordonnier C, Al-Shahi Salman R, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet. 2016;387(10038):2605-2613.

Beslow LA, Ichord RN, Gindville MC, et al. Frequency of hematoma expansion after pediatric intracerebral hemorrhage. Stroke. 2014;45(6):1822-1824.

Brouwers HB, Chang Y, Falcone GJ, et al. Predicting hematoma expansion after primary intracerebral hemorrhage. JAMA Neurol. 2014;71(2):158-164.

Caceres JA, Goldstein JN. Intracranial hemorrhage. Emerg Med Clin North Am. 2012;30(3):771-794.

Charidimou A, Turc G, Oppenheim C, et al. Microbleeds, cerebral hemorrhage, and functional outcome after stroke thrombolysis. Stroke. 2017;48(8):2084-2090.

Davis SM, Broderick J, Hennerici M, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006;66(8):1175-1181.

Delcourt C, Huang Y, Arima H, et al. Hematoma growth and outcomes in intracerebral hemorrhage: the INTERACT1 study. Neurology. 2012;79(4):314-319.

Elliott J, Smith M. The acute management of intracerebral hemorrhage: a clinical review. Anesth Analg. 2010;110(5):1419-1427.

Flaherty ML, Haverbusch M, Sekar P, et al. Long-term mortality after intracerebral hemorrhage. Neurology. 2006;66(8):1182-1186.

Goldstein JN, Fazen LE, Snider R, et al. Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage. Neurology. 2007;68(12):889-894.

Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891-897.

Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032-2060.

Inagawa T. Primary intracerebral hemorrhage in Izumo City, Japan: incidence rates and outcome in relation to the site of hemorrhage. Neurosurgery. 2003;53(6):1283-1297.

Kazui S, Naritomi H, Yamamoto H, et al. Enlargement of spontaneous intracerebral hemorrhage. Incidence and time course. Stroke. 1996;27(10):1783-1787.

Keep RF, Hua Y, Xi G. Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. Lancet Neurol. 2012;11(8):720-731.

Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):e259-281.

Li Q, Warren AD, Qureshi AI, et al. Ultra-early blood pressure reduction attenuates hematoma growth and improves outcome in intracerebral hemorrhage. Ann Neurol. 2020;88(2):388-395.

Lord AS, Gilmore E, Choi HA, Mayer SA. Time course and predictors of neurological deterioration after intracerebral hemorrhage. Stroke. 2015;46(3):647-652.

Mendelow AD, Gregson BA, Rowan EN, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013;382(9890):397-408.

Morotti A, Goldstein JN. Diagnosis and management of acute intracerebral hemorrhage. Emerg Med Clin North Am. 2016;34(4):883-899.

Naval NS, Abdelhak TA, Urrunaga N, et al. An association of prior statin use and decreased mortality in patients with intracerebral hemorrhage. Neurocrit Care. 2008;8(1):6-12.

Phan TG, Koh M, Vierkant RA, Wijdicks EF. Hydrocephalus is a determinant of early mortality in putaminal hemorrhage. Stroke. 2000;31(9):2157-2162.

Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet. 2009;373(9675):1632-1644.

Rodriguez-Luna D, Piñeiro S, Rubiera M, et al. Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage. Eur J Neurol. 2013;20(9):1277-1283.

Romero JM, Brouwers HB, Lu J, et al. Prospective validation of the computed tomographic angiography spot sign score for intracerebral hemorrhage. Stroke. 2013;44(11):3097-3102.

Rosand J, Eckman MH, Knudsen KA, Singer DE, Greenberg SM. The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch Intern Med. 2004;164(8):880-884.

Sahni R, Weinberger J. Management of intracerebral hemorrhage. Vasc Health Risk Manag. 2007;3(5):701-709.

Selariu E, Zia E, Brizzi M, Abul-Kasim K. Swirl sign in intracerebral haemorrhage: definition, prevalence, reliability and prognostic value. BMC Neurol. 2012;12:109.

Sprigg N, Flaherty K, Appleton JP, et al. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet. 2018;391(10135):2107-2115.

Steiner T, Al-Shahi Salman R, Beer R, et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke. 2014;9(7):840-855.

Steiner T, Diringer MN, Schneider D, et al. Dynamics of intraventricular hemorrhage in patients with spontaneous intracerebral hemorrhage: risk factors, clinical impact, and effect of hemostatic therapy with recombinant activated factor VII. Neurosurgery. 2006;59(4):767-773.

Thompson BB, Béjot Y, Caso V, et al. Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review. Neurology. 2010;75(15):1333-1342.

Toyoda K, Okada Y, Minematsu K, et al. Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage. Neurology. 2005;65(7):1000-1004.

Wada R, Aviv RI, Fox AJ, et al. CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage. Stroke. 2007;38(4):1257-1262.

Wang X, Arima H, Al-Shahi Salman R, et al. Clinical prediction algorithm (BRAIN) to determine risk of hematoma growth in acute intracerebral hemorrhage. Stroke. 2015;46(2):376-381.

Zazulia AR, Diringer MN, Derdeyn CP, Powers WJ. Progression of mass effect after intracerebral hemorrhage. Stroke. 1999;30(6):1167-1173.