Adrenal Haemorrhagic Infarction Research Articles

Unilateral adrenal hemorrhagic infarction in essential thrombocythemia

Adrenal hemorrhage is a rare disease associated with various conditions. We report a case of a 68-year-old woman with abdominal and back pain. The diagnostic work-up showed a left adrenal gland infarction associated with essential thrombocythemia. Treatment consisted in painkillers and treating the underlying condition in order to prevent further thrombotic events.

Acute adrenal insufficiency due to bilateral adrenal haemorrhagic infarction associated with sepsis secondary to an open fracture of the ankle

Acute adrenal insufficiency due to bilateral adrenal haemorrhagic infarction associated with sepsis secondary to an open fracture of the ankle

Abdominal Pain and Severe Hyponatremia After Lung Cancer Surgery

We report a 54-year-old man who presented with abdominal pain and severe hyponatremia a few days after a left lower lobectomy for lung cancer. An abdominal computed tomography scan without contrast showed a bilateral adrenal hemorrhagic infarction, mainly on the right side. Serum sodium level was 113 mmol/L, and cortisol level was 0 microg/L. Anticardiolipin-type antibodies (immunoglobulin G isotype) level was 75 GPL/mL (normal value < 10). With hydrocortisone supplementation and curative doses of low-molecular-weight heparin, the patient recovered progressively and was discharged on postoperative day 17. Final diagnosis was bilateral adrenal gland hemorrhagic necrosis leading to adrenal insufficiency, associated with antiphospholipid syndrome. We discuss the mechanism and the role of the operation in the occurrence of this particularly rare and potentially life-threatening complication. Recommendations to prevent thrombosis in surgical patients who have antiphospholipid antibodies are lacking.

Catastrophic antiphospholipid syndrome presented with severe hypertension, adult respiratory distress syndrome and unilateral adrenal haemorrhagic infarction

We are reporting a case of catastrophic antiphospholipid syndrome (CAPS) in an adult female manifested with severe hypertension followed by adrenal haemorrhagic infarction and adult respiratory distress syndrome. Adrenal involvement appears to be exceedingly high in CAPS and adult respiratory distress syndrome (ARDS) is the prevailing pulmonary manifestation in this condition, compared with these impediments in patients with simple antiphospholipid syndrome (APS). Even though the above manifestations are well recognized, their combination as an initial presentation of CAPS is uncommon.

Adrenal involvement in the antiphospholipid syndrome.

Although Addison disease and hypoadrenalism are rare in patients with systemic lupus erythematosus (SLE), early reports of the association suggested the presence of antiphospholipid antibodies (aPL) in these patients. Data from literature reveal that adrenal failure was present in between 10 and 26% of patients with catastrophic APS and that one-third of patients presented with adrenal involvement during the course of catastrophic APS. Adrenal involvement may be the first clinical manifestation of this syndrome, whereas a few patients may have a history of Addison's disease in the past. The pathological mechanisms involved in the production of adrenal insufficiency in APS are still not clearly understood, but the hypercoagulable state in these patients supports the concept that adrenal haemorrhagic infarction may possibly be related to adrenal vein thrombosis. In the present article,we review the pathogenic mechanisms and main clinical, laboratory and treatment features of patients suffering adrenal involvement with aPL to support the idea that APS leads to the development of adrenal insufficiency.

ARDS and Adrenal Insufficiency Associated With the Antiphospholipid Antibody Syndrome

The antiphospholipid antibody syndrome (APS) is typically characterized by recurrent arterial and/or venous thromboses, miscarriages, and thrombocytopenia. There have been five reported cases of ARDS associated with primary APS. Adrenal insufficiency has also been reported as a rare complication of APS. We report a case of both ARDS and adrenal insufficiency associated with primary APS. Chest radiographs and pulmonary angiography studies revealed findings consistent with ARDS. CT scans confirmed the presence of bilateral adrenal hemorrhagic infarction. Patients with APS are at an increased risk of widespread vascular thrombosis due to the presence of circulating antiphospholipid antibodies. This case emphasizes the importance of recognizing APS and its potential for multiple organ system involvement.

Heparin-induced skin lesions.

Six patients who developed heparin-induced skin lesions were tested for the presence of heparin-dependent, platelet-activating IgG irrespective of whether they developed thrombocytopenia. All six patients' sera contained potent heparin-dependent, platelet-activating IgG. However, only two of the six patients developed thrombocytopenia, and both of these patients developed thrombotic complications. One of the four patients who developed skin lesions without thrombocytopenia also developed a characteristic complication of heparin-induced thrombocytopenia (adrenal haemorrhagic infarction). These observations indicate that formation of heparin-dependent, platelet-activating IgG is a consistent feature of patients who developed heparin-induced skin lesions irrespective of whether thrombocytopenia occurs.