Abstract
IntroductionBilateral adrenal haemorrhage is a rare cause of adrenal failure. Clinical features are non-specific and therefore a high index of suspicion must be maintained in patients at risk. Predisposing factors include infection, malignancy and the post-operative state.Case presentationWe report the case of a patient who underwent a left hemicolectomy with primary anastomosis and formation of a defunctioning loop ileostomy for an obstructing colon carcinoma at the splenic flexure. En-bloc splenectomy was performed to ensure an oncologic resection. The patient developed a purulent abdominal collection post-operatively and became septic with hypotension and pyrexia. This precipitated acute bilateral adrenal haemorrhage with consequent adrenal insufficiency. Clinical suspicion was confirmed by radiological findings and a co-syntropin test. Following drainage of the collection, antibiotic therapy and corticosteroid replacement, the patient made an excellent recovery.ConclusionThis case highlights the importance of prompt diagnosis and treatment of adrenal failure. In their absence, this condition can rapidly lead to death of the patient.
Highlights
Bilateral adrenal haemorrhage is a rare cause of adrenal failure
Case presentation: We report the case of a patient who underwent a left hemicolectomy with primary anastomosis and formation of a defunctioning loop ileostomy for an obstructing colon carcinoma at the splenic flexure
We present the case of an elderly male patient with acute adrenal insufficiency due to bilateral adrenal haemorrhage following an emergency bowel resection and en-bloc splenectomy complicated by intra-abdominal sepsis
Summary
Bilateral adrenal haemorrhage is rarely diagnosed clinically as its presentation is generally non-specific. A repeat CT scan of thorax, abdomen and pelvis some five weeks later (with intravenous contrast, renal function having returned to normal) demonstrated metastatic lung and liver lesions and interval liquefaction of the adrenal gland haemorrhages (Figure 2). He continues to take oral hydrocortisone, is on lifelong penicillin prophylactically and remains clinically well at out-patient follow-up six months later. Seven hours after commencement of steroid therapy the noradrenaline infusion was discontinued as the patient’s blood pressure had stabilised He was transferred to the ward on post-operative day ten and the hydrocortisone was changed to oral administration. Prior to discharge from hospital, hydrocortisone was stopped for 24 hours and a cosyntropin stimulation test
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