Abstract
Acute adrenal hemorrhage (adrenal apoplexy) in the context of severe sepsis is potentially life-threatening. Diagnosis of this condition is difficult to achieve without a strong sense of suspicion. The concurrent use of anticoagulants increases the risk of adrenal hemorrhage in the context of sepsis. Abdominal CT imaging is helpful in detecting hemorrhage within the adrenal gland. Once the diagnosis is considered, prompt therapy with corticosteroids can improve recovery and survival. A follow-up scan to confirm the resolution of the hematoma is useful to ensure that there is no other cause of adrenal enlargement. We report a 76-year-old lady who was hospitalized because of unexplained anemia and abdominal pain and was discovered to have bilateral pneumonia and urinary tract infection with severe hypotension not responding to standard treatments. An abdominal CT scan confirmed the presence of bilateral adrenal hemorrhage. A subsequent finding of an inappropriately low serum cortisol level in the presence of physiological stress confirmed adrenal insufficiency. The patient’s condition improved following corticosteroid replacement. A repeat CT scan performed 10 months following the patient’s initial presentation demonstrated signs of resolution of the adrenal hematomas; however, the patient’s adrenal function remained impaired.
Highlights
Adrenal hemorrhage is a term used to describe acute bleeding into the adrenal gland
It is similar and referred to as Waterhouse Friderichsen Syndrome (WFS), which occurs in the setting of severe sepsis usually caused by meningococcal bacteremia [1]
In severely ill patients suspected of having adrenal insufficiency, a stimulated increment in the cortisol level below 248.3 nmol/L or a random total cortisol level below 275.9 nmol/L is diagnostic [4]
Summary
Adrenal hemorrhage (adrenal apoplexy) is a term used to describe acute bleeding into the adrenal gland. We present a case of spontaneous bilateral adrenal hemorrhage in a 76-year-old lady who was initially hospitalized due to unexplained anemia and abdominal pain and found to have bilateral pneumonia, urinary tract infection, and intractable hypotension. A 76-year-old lady was admitted to hospital when she was discovered to have severe anemia (hemoglobin level of 61 g/L, packed cell volume of 0.191 L/L, mean cell volume of 94.6 fl) while on oral anticoagulant therapy (prothrombin time ratio of 3.7) She had a four-week history of non-specific left-sided abdominal pain, nausea, reduced appetite, passing dark stools, and breathlessness on exertion. A random cortisol assay performed on a morning blood sample revealed severe hypocortisolemia (serum cortisol of 23 nmol/L) in the presence of severe physiological stress and sepsis This result was a diagnostic of adrenal failure. The patient remains on long-term corticosteroid replacement therapy, and has been started on a direct oral anticoagulant
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
