Case Of Bilateral Adrenal Hemorrhage Research Articles

Hémorragie bilatérale des surrénales sous apixaban dans le syndrome primaire des antiphospholipides

Adrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome.We present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in 53-year-old women treated by apixaban for previous venous thromboembolism.

Histopathological Analysis of Adrenal Glands after Simian Varicella Virus Infection.

Latent varicella zoster virus (VZV) has been detected in human adrenal glands, raising the possibility of virus-induced adrenal damage and dysfunction during primary infection or reactivation. Rare cases of bilateral adrenal hemorrhage and insufficiency associated with VZV reactivation have been reported. Since there is no animal model for VZV infection of adrenal glands, we obtained adrenal glands from two non-human primates (NHPs) that spontaneously developed varicella from primary simian varicella virus (SVV) infection, the NHP VZV homolog. Histological and immunohistochemical analysis revealed SVV antigen and DNA in the adrenal medulla and cortex of both animals. Adrenal glands were observed to have Cowdry A inclusion bodies, cellular necrosis, multiple areas of hemorrhage, and varying amounts of polymorphonuclear cells. No specific association of SVV antigen with βIII-tubulin-positive nerve fibers was found. Overall, we found that SVV can productively infect NHP adrenal glands, and is associated with inflammation, hemorrhage, and cell death. These findings suggest that further studies are warranted to examine the contribution of VZV infection to human adrenal disease. This study also suggests that VZV infection may present itself as acute adrenal dysfunction with “long-hauler” symptoms of fatigue, weakness, myalgias/arthralgias, and hypotension.

A novel case of bilateral adrenal hemorrhage and acute adrenal insufficiency due to VITT (vaccine induced thrombosis and thrombocytopenia) syndrome

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Abstract #1002785: A Case of Bilateral Adrenal Hemorrhage Associated with COVID-19

COVID-19 infection has been reported to be associated with coagulopathy and thromboembolic events. There are a few case reports of bilateral adrenal hemorrhage (BAH) associated with COVID-19 in the existing English literature. Here we report, to the best of our knowledge, the first such case of BAH associated with COVID-19 in the US.

SUN-192 Spontaneous Adrenal Hemorrhage in a Patient with Antiphospholipid Syndrome on Rivaroxaban: A Potentially Fatal Complication

Introduction: Primary Adrenal insufficiency is an uncommon complication of antiphospholipid syndrome, with an incidence of 0.4% [2]. It is often secondary to bilateral adrenal hemorrhage. We present a case of bilateral adrenal hemorrhage in a patient with APLS on anticoagulation with rivaroxaban. Case: 46-year-old m with a history of antiphospholipid syndrome, recently transitioned from warfarin to rivaroxaban for anticoagulation, who presented to the ED after a syncopal episode following a prior episode of abdominal pain with an unremarkable work-up. He subsequently developed severe fatigue, dizziness, headaches, nausea and 15 lbs weight loss. On presentation, the patient was hypotensive(72/45 mmHg) and tachycardic. Intravenous hydration was started with minimal response. Initial laboratory testing showed serum sodium of 121mmol/L, potassium of 5.5mmol/L and random cortisol of 0.8mcg/dL. The patient was admitted to the intensive care unit where he was started on vasopressors and hydrocortisone 50 mg IV every 8 hours. A non-contrast CT of the abdomen and pelvis showed thickening of the adrenal glands with decreased attenuation. MRI of the abdomen showed hyper-intensity of the adrenal glands bilaterally (T1 images), without post-contrast enhancement suggestive of bilateral adrenal hemorrhage. His electrolytes normalized, and he was successfully discharged home on hydrocortisone and fludrocortisone replacement with outpatient follow-up. Discussion: Atraumatic bilateral adrenal hemorrhage is rare, but remains one of the most common endocrine-related complications of antiphospholipid syndrome (APLS). The venous anatomical configuration of the adrenal gland increases risk of thrombotic hemorrhagic infarction[1]. Patients with APLS are commonly anticoagulated to prevent thrombosis. The ideal anticoagulation regimen remains controversial. Only three other cases of spontaneous bilateral adrenal hemorrhage on patients with APLS using new oral anticoagulants (NOACs) were reported. The use of NOACs seem to increase the already-elevated risk of adrenal hemorrhage seen in patients with APLS.

Nécrose hémorragique bilatérale des surrénales sous apixaban : penser au syndrome des antiphospholipides ?

IntroductionAdrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome. Case reportWe present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in a 47-year-old man treated by apixaban for previous venous thromboembolism. ConclusionTo our knowledge, it is the first case of adrenal hemorrhage occurring during apixaban treatment in a patient with antiphospholipid syndrome. This case illustrates the inefficacy of direct oral anticoagulants to prevent thrombotic events in antiphospholipid syndrome, in accordance with the latest recommendations.

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

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.

A Case Of Bilateral Adrenal Hemorrhage and Subsequent Adrenal Crisis due to Heparin-Induced Thrombocytopenia

ABSTRACT Objective: To discuss a case of adrenal insufficiency (AI) caused by heparin-induced thrombocytopenia (HIT) and subsequent adrenal hemorrhage. Methods: We describe the case of a patient who developed postoperative HIT, which went undetected until the patient presented with fulminant adrenal crisis. We provide here an overview of the work-up, diagnosis, and treatment of HIT-associated AI. Results: HIT is a rare cause of bilateral adrenal hemorrhage, and subsequent AI secondary to HIT is often clinically unsuspected until overt hemodynamic collapse occurs. Conclusions: Lack of early detection and appropriate treatment of HIT-induced AI can lead to significant patient morbidity and mortality. Awareness of this clinical condition is key to early recognition and treatment.

Severe bilateral adrenal hemorrhages in a newborn complicated by persistent adrenal insufficiency.

SummaryBilateral adrenal hemorrhages rarely occur during the neonatal period and are often associated with traumatic vaginal deliveries. However, the adrenal gland has highly regenerative capabilities and adrenal insufficiency typically resolves over time. We evaluated a newborn female after experiencing fetal macrosomia and a traumatic vaginal delivery. She developed acidosis and acute renal injury. Large adrenal hemorrhages were noted bilaterally on ultrasound, and she was diagnosed with adrenal insufficiency based on characteristic electrolyte changes and a low cortisol (4.2 µg/dL). On follow-up testing, this patient was unable to be weaned off of hydrocortisone or fludrocortisone despite resolution of hemorrhages on ultrasound. Providers should consider bilateral adrenal hemorrhage when evaluating critically ill neonates after a traumatic delivery. In extreme cases, this may be a persistent process.Learning points:Risk factors for adrenal hemorrhage include fetal macrosomia, traumatic vaginal delivery and critical acidemia.Signs of adrenal hemorrhage include jaundice, flank mass, skin discoloration or scrotal hematoma.Adrenal insufficiency often is a transient process when related to adrenal hemorrhage.Severe adrenal hemorrhages can occur in the absence of symptoms.Though rare, persistent adrenal insufficiency may occur in extremely severe cases of bilateral adrenal hemorrhage.Consider adrenal hemorrhage when evaluating a neonate for shock in the absence of an infectious etiology.

Adrenal crisis secondary to bilateral adrenal haemorrhage after hemicolectomy.

SummaryAdrenal haemorrhage is a rare cause of adrenal crisis, which requires rapid diagnosis, prompt initiation of parenteral hydrocortisone and haemodynamic monitoring to avoid hypotensive crises. We herein describe a case of bilateral adrenal haemorrhage after hemicolectomy in a 93-year-old female with high-grade colonic adenocarcinoma. This patient’s post-operative recovery was complicated by an acute hypotensive episode, hypoglycaemia and syncope, and subsequent computed tomography (CT) scan of the abdomen revealed bilateral adrenal haemorrhage. Given her labile blood pressure, intravenous hydrocortisone was commenced with rapid improvement of blood pressure, which had incompletely responded with fluids. A provisional diagnosis of hypocortisolism was made. Initial heparin-induced thrombocytopenic screen (HITTS) was positive, but platelet count and coagulation profile were both normal. The patient suffered a concurrent transient ischaemic attack with no neurological deficits. She was discharged on a reducing dose of oral steroids with normal serum cortisol levels at the time of discharge. She and her family were educated about lifelong steroids and the use of parenteral steroids should a hypoadrenal crisis eventuate.Learning points:Adrenal haemorrhage is a rare cause of hypoadrenalism, and thus requires prompt diagnosis and management to prevent death from primary adrenocortical insufficiency.Mechanisms of adrenal haemorrhage include reduced adrenal vascular bed capillary resistance, adrenal vein thrombosis, catecholamine-related increased adrenal blood flow and adrenal vein spasm.Standard diagnostic assessment is a non-contrast CT abdomen.Intravenous hydrocortisone and intravenous substitution of fluids are the initial management.A formal diagnosis of primary adrenal insufficiency should never delay treatment, but should be made afterwards.

Bilateral Adrenal Hemorrhage in a Patient with Antiphospholipid Syndrome

Bilateral adrenal hemorrhage is relatively uncommon, with a reported incidence in the United States of 0.3-1.8% in hospital post-mortems1.Clinical manifestations of adrenal hemorrhage are widely variable, making diagnosis a challenge. Left undiagnosed and untreated, bilateral adrenal hemorrhage may lead to cardiovascular collapse and/or death. Here we present a rare case of bilateral adrenal hemorrhage in a patient with antiphospholipid syndrome; the aim of this case, and the corresponding literature review, is to highlight risk factors for and management of this condition.

A case of bilateral adrenal haemorrhage following traumatic brain injury.

We report the case of a 57-year-old man who sustained an isolated severe traumatic brain injury (TBI). During his admission to the intensive care unit (ICU), he developed marked arterial hypotension of unclear cause. Eventually, the presence of renal angle tenderness on clinical examination and a low random-cortisol level lead to the suspicion of primary adrenal insufficiency. A computed tomography scan of his abdomen demonstrated new bilateral adrenal haemorrhages. This diagnosis is not unlikely to be missed, as symptoms and laboratory tests are often nonspecific.

Bilateral Adrenal Hemorrhage in a Patient with Myelodysplastic Syndrome: Value of MRI in the Differential Diagnosis

Bilateral adrenal hemorrhage is a rare potentially life-threatening event that occurs either in traumatic or nontraumatic conditions. The diagnosis is often complicated by its nonspecific presentation and its tendency to intervene in stressful critical illnesses. Due to many disorders in platelet function, hemorrhage is a major cause of morbidity and mortality in patients affected by myeloproliferative diseases. We report here the computed tomography and magnetic resonance imaging findings of a rare case of bilateral adrenal hemorrhage in a patient with myelodysplastic syndrome, emphasizing the importance of MRI in the differential diagnosis.

Bilateral Adrenal Hemorrhage after Blunt Abdominal Trauma

Introduction Adrenal insufficiency associated with bilateral adrenal hemorrhage after blunt torso trauma is uncommon and may not be suspected as a cause of hemodynamic instability in a patient with multi-system trauma. Without appropriate treatment, acute adrenal failure is associated with major complications and death. Only a few cases of bilateral adrenal hemorrhage after blunt trauma have been reported. We present a patient who suffered multiple injuries in a motor vehicle collision, including bilateral adrenal hemorrhage. The patient’s injuries resulted in adrenal insufficiency, which required steroid supplementation.

Adrenal Insufficiency After Laparoscopic Hysterectomy in a Patient With Primary Antiphospholipid Syndrome

We report a case of bilateral adrenal hemorrhage and subsequent adrenal insufficiency after a laparoscopic hysterectomy in a patient with anticardiolipin antibody syndrome. A 55-year-old woman with a history of anticardiolipin antibody syndrome presented with nausea and vomiting 1 week after laparoscopic hysterectomy and staging for endometrial adenocarcinoma. Based on a diagnosis of adrenal insufficiency, the patient was started on oral hydrocortisone 20 mg in the morning and 10 mg in the afternoon, and fludrocortisone 0.05 mg twice daily on day 5. Her symptoms resolved completely within 24 hours of beginning steroids. The diagnosis of adrenal insufficiency should be entertained in any patient with a history of thrombophilias presenting with general abdominal complaints.

Syndrome de Waterhouse-Friderichsen au cours d'une péritonite à Morganella morganii et Enterococcus faecium

About fifty to sixty percent of patients with septic shock acquire acute adrenal insufficiency. This insufficiency is most often relative, but can sometimes be absolute. Bilateral adrenal haemorrhage is a rare aetiology of absolute acute adrenal insufficiency. It is classically described in patients with severe meningococcemia (purpura fulminans), who commonly present many of the risk factors associated with bilateral adrenal haemorrhage (shock, coagulation disorders, sepsis). We report a case of bilateral adrenal haemorrhage during a peritonitis complicated by a septic shock, with no coagulation disorder. This observation shows up that this bilateral adrenal haemorrhage can complicate severe sepsis of various origins, and not only severe meningococcemia. It can be suspected in face of a septic shock with an unfavourable evolution despite adequate treatment.

Bilateral adrenal hemorrhage associated with heparin induced thrombocytopenia

Heparin induced thrombocytopenia (HIT) is associated with serious and sometimes devastating thrombotic events. We report a case of bilateral adrenal hemorrhage (BAH) associated with HIT after prophylactic use of low molecular weight heparin. The vague presenting symptoms of acute adrenal insufficiency offers a diagnostic challenge, which if delayed may be life threatening. A high index of suspicion for adrenal hemorrhage is required in patients receiving any form of heparin therapy presenting with new onset thrombocytopenia, abdominal pain, and fevers.

Adrenal Haemorrhage with Cholestasis and Adrenal Crisis in a Newborn of a Diabetic Mother

The large hyperaemic foetal adrenal gland is vulnerable to vascular damage. This may occur in the neonatal period as a consequence of difficult labour, or its aetiology may not be apparent. The spectrum of presentation is considerable, ranging from asymptomatic to severe life-threatening intra-abdominal haemorrhage. The presentation of adrenal insufficiency may be delayed but the regenerative capacity of the adrenal is great, and most adrenal haemorrhage is not associated with significantly impaired function. Some reports showed that cholestatic hepatopathy with congenital hypopituitarism reversed by hydrocortisone treatment is considered in the context of the endocrine syndrome, probably as a consequence of the adrenal failure. We describe a case of bilateral adrenal haemorrhage with hepatitis syndrome and persistent hypoglycaemia in a newborn male with striking features of neonatal cholestasis and adrenal crisis.

Heparin-Induced Thrombocytopenia Associated With Bilateral Adrenal Hemorrhage After Coronary Artery Bypass Surgery

Heparin-induced thrombocytopenia (HIT) is a well-recognized syndrome associated with thrombosis and multiple potential clinical sequelae. We report a case of bilateral adrenal hemorrhage, a known but rare complication of heparin-induced thrombocytopenia complicating a routine coronary artery bypass surgery. Thrombocytopenia, abdominal pain, and signs of adrenal insufficiency in the context of heparin treatment should raise suspicion of this unusual complication.

Bilateral massive adrenal haemorrhage revealing coeliac disease

Sir, We describe a case of coeliac disease that remained undiagnosed for many years and induced a hypocoagulant state and bilateral adrenal haemorrhage. This is the first reported case of bilateral adrenal haemorrhage in a patient with this disorder. A 43-year-old woman presented with sub-acute back pain requiring morphine. She did not smoke, drink alcohol, or take medications or illicit drugs. Physical examination revealed severe cachexia (BMI 15 kg/m2). She was afebrile, with a blood pressure of 110/75 mmHg. She reported a 10-year history of progressive unexplained weight loss with lack of energy. There was no decrease in appetite until 6 months prior, when she began to limit her intake due to persistent diarrhoea. Laboratory investigation revealed potassium …