MON-367 A Case of Bilateral Adrenal Hemorrhage Initially Diagnosed as Bilateral Adrenal Adenomas in a Patient without Typical Risk Factors

Abstract

Background: Adrenal insufficiency secondary to bilateral adrenal hemorrhage in adults is a rare but life-threatening occurrence. Rarer still are cases of bilateral adrenal hemorrhage in atraumatic patients not on anticoagulation and without bleeding or clotting disorders. Clinical Case: We report a case of a 78 year old woman found to have bilateral adrenal hemorrhage. Patient was taking aspirin 81mg daily but she was not on anticoagulant medication. She has no history of bleeding or clotting disorders. She denies recent trauma or surgery. Patient initially presented with recurrent syncope and hypotension and CT scan of the abdomen and pelvis revealed bilateral adrenal masses. Work-up of adrenal masses was negative for pheochromocytoma and Cushing’s syndrome. Magnetic resonance imaging of the abdomen was then performed which revealed bilateral adrenal hemorrhage. Patient subsequently underwent a cosyntropin stimulation test and this was consistent with adrenal insufficiency. Conclusions: Adrenal hemorrhage should be on the differential in the event of bilateral adrenal masses diagnosed on CT scan. In this case, MRI was diagnostic of adrenal hemorrhage while CT was not. This patient required both glucocorticoid and mineralocorticoid replacement. Patient recovered and did well after adrenal replacement was started.