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Rijal R, Kandel K, Aryal BB, Asija A, Shrestha DB, Sedhai YR. Waterhouse-Friderichsen syndrome, septic adrenal apoplexy. VITAMINS AND HORMONES 2023; 124:449-461. [PMID: 38408808 DOI: 10.1016/bs.vh.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Waterhouse-Friderichsen syndrome is a rare but potentially fatal disorder of the adrenal gland characterized by bilateral adrenal hemorrhage. It is classically a result of meningococcal sepsis and presents acutely with features of shock, petechial rashes, abdominal pain, and non-specific symptoms such as headache, fatigue, and vomiting. Treatment consists of fluid resuscitation, corticosteroid replacement, and possibly surgery. The prognosis is poor despite treatment. This chapter will review the etiology, pathogenesis, clinical features, and management of the disease.
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Affiliation(s)
- Rishikesh Rijal
- University of Louisville School of Medicine, Louisville, KY, United States.
| | - Kamal Kandel
- Matri Shishu Miteri Hospital, Gandaki Province, Nepal
| | - Barun Babu Aryal
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, United States.
| | - Ankush Asija
- Division of Nephrology, Indiana University, Indianapolis, IN, United States.
| | | | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, United States.
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2
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Spontaneous Adrenal Hemorrhage with Mild Hypoadrenalism in a Patient Anticoagulated with Apixaban for Antiphospholipid Syndrome: A Case Report and Literature Review. Case Rep Endocrinol 2022; 2022:6538800. [PMID: 36504598 PMCID: PMC9729038 DOI: 10.1155/2022/6538800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background Adrenal hemorrhage (AH) is a serious endocrine complication of antiphospholipid syndrome (APLS). Case Presentation. We report a 45-year-old man who presented with several deep venous thromboses and was initially treated with apixaban, who later developed bilateral AH. Laboratory findings were consistent with cortisol deficiency yet preserved aldosterone physiology. He was diagnosed with APLS and treated with warfarin. After 8 months of follow-up, he remained on cortisol replacement with no evidence of recovery. We reviewed PubMed/MEDLINE indexed articles from 1950 to 2022 for cases of AH in APLS patients on anticoagulation. Six cases of patients on direct oral anticoagulants (DOACs) were reported. Discussion. The unique vasculature of the adrenal glands creates a "functional vascular dam" in the zona reticularis, which is susceptible to thrombosis in situ and hemorrhage. DOACs may further increase the risk of AH. Conclusion Depending on the degree of adrenal involvement in AH, patients can present with partial or complete primary adrenal insufficiency. More data are needed to characterize adrenal function after AH, and the safety of DOAC versus warfarin in patients with APLS warrants further studies.
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3
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Lee N, Choi J, Yoon J. Presumptive nontraumatic adrenal hemorrhage preceding hypoadrenocorticism in a dog. Vet Med (Auckl) 2022; 36:2160-2164. [PMID: 36086914 DOI: 10.1111/jvim.16531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
Nontraumatic adrenal hemorrhage (NTAH) has been associated with stress-induced catecholamines release in underlying conditions such as sepsis and recent surgery in humans. It can lead to primary hypoadrenocorticism (HOAC) when both adrenal glands are involved, with nonspecific clinical signs and laboratory findings that can lead to a missed diagnosis. Bilateral thickening of the adrenal glands with periadrenal fat stranding was identified in a 10-year-old male Maltese dog after abdominal surgery. The dog showed clinical signs and biochemical changes consistent with HOAC, but treatment for presumed critical illness-related corticosteroid insufficiency was initiated. Clinical signs relapsed with a 3-week dose reduction of hydrocortisone, and a reduction in adrenal size was observed on follow-up ultrasound examination. Hormonal testing confirmed HOAC in the dog. To the best of our knowledge, HOAC caused by spontaneous NTAH has not been reported in the veterinary literature. This report describes a dog that developed HOAC with presumed adrenal atrophy after suspected spontaneous bilateral NTAH.
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Affiliation(s)
- Namsoon Lee
- Time Animal Medical Center, Daejeon, South Korea.,College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Jihye Choi
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Junghee Yoon
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
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Patel E, Zill-E-Huma R, Demertzidou E. Spontaneous adrenal haemorrhage in pregnancy and review of the literature. BMJ Case Rep 2022; 15:e246240. [PMID: 35523516 PMCID: PMC9083427 DOI: 10.1136/bcr-2021-246240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/04/2022] Open
Abstract
Spontaneous adrenal haemorrhage (SAH) is a rare condition. The incidence of adrenal haemorrhage in pregnancy is currently not known; however, an association with pregnancy has been reported.An acute presentation with severe back or flank pain should raise suspicion of this condition. Diagnosis is based on imaging. An ultrasound scan is a basic and readily available investigation in pregnancy to rule out renal and suprarenal pathology while CT or MRI scan can help to confirm the diagnosis. A multidisciplinary team (MDT) approach, involving the obstetric, anaesthetic, medical and endocrine team, is essential in management of this condition.We present a case of an SAH; managed conservatively, in an otherwise healthy and low-risk pregnant woman and describe the literature review on this rare condition, including pathophysiology and management.
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Affiliation(s)
- Ekta Patel
- Obstetrics and Gynaecology, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | | | - Eleftheria Demertzidou
- Obstetrics and Gynaecology, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
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5
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Zulu S. Unilateral left spontaneous adrenal haemorrhage in a middle aged male. A case report. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Proposition of a Simplified Protocol and New Parameter Introduction in NMRI Mice Anhedonia Induction. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2020-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Abstract
Introduction: A broad spectrum of research involving stress and stress protocols has long proven that a point of anhedonia, social defeat and learned helplessness can be achieved and observed – with anhedonia being a clinical symptom of Anxiety, Depression and Bipolar Affective Disorder.
Aim: The aim of this study is the development of a simplified protocol for anhedonia induction in NMRI male mice in order to shorten the period of mice suffering and decrease complexity of the procedure for other researchers and introduction of new parameter in order to achieve better standardization of results.
Materials and Methods: 21 male NMRI mice were introduced to 2 different stress protocols (one found in literature and one simplified) where cognitive- behavioral status was tested using the Sucrose Preference Test, Open Field Test, Grooming Pattern and histological examination of adrenal glands, and to propose a new protocol for fellow researchers.
Results: Results observed include the successful induction of anhedonia proven by Sucrose Preference Tests, Barbering effect and microhemorrhage of the adrenal glands. Simplified protocol showed superiority compared to the one found in literature.
Conclusion: Simplified protocol showed higher efficiency and reduced amount of work during testing phase. Introduction of NMI as a new parameter during behavioral evaluation resulted in better standardization of measured SPT values that incorporates common knowledge of mammal physiology. A big developmental step was the introduction of the Normalised Mass Index to even out mass fluctuations and differences in basal metabolism, which we recommend to other researchers and institutions.
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Di Serafino M, Viscardi D, Iacobellis F, Giugliano L, Barbuto L, Oliva G, Ronza R, Borzelli A, Raucci A, Pezzullo F, De Cristofaro MG, Romano L. Computed tomography imaging of septic shock. Beyond the cause: the "CT hypoperfusion complex". A pictorial essay. Insights Imaging 2021; 12:70. [PMID: 34089401 PMCID: PMC8178660 DOI: 10.1186/s13244-021-01006-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/05/2021] [Indexed: 12/17/2022] Open
Abstract
Septic shock is a medical emergency that represents one of the most important underlying causes for presentation to the Emergency Department. Sepsis is defined as organ dysfunction, life-threatening event caused by a deregulated inflammatory host response to infection, with a mortality risk ranging from 10 to 40%. Early sepsis identification is the cornerstone of management and diagnostic imaging can play a pivotal role in this clinical context. The choice of imaging modality depends on several factors, associated with the clinical condition and the presence or absence of localising signs and symptoms. The diagnostic accuracy of contrast-enhanced total-body CT has been well established during septic shock, allowing for a rapid, panoramic, and detailed study of multiple body areas, simultaneously. The aim of this article is to illustrate the controversial CT hypoperfusion complex in patients with septic shock, characterised by the following imaging features: decreased enhancement of the viscera; increased mucosal enhancement; luminal dilation of the small bowel; mural thickening and fluid-filled loops of the small bowel; the halo sign and flattening of the inferior vena cava; reduced aortic diameter; peripancreatic oedema; abnormal parenchymal perfusion; and other controversial findings that are variably associated with each other and reversible during the early stages. Increasing physicians' awareness of the significance of these findings could prompt alternative approaches to the early assessment and management of septic shock. In this perspective, CT imaging represents a useful tool for a complete, rapid and detailed diagnosis of clinically suspected septic shock, which can be used to improve patient outcomes.
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Affiliation(s)
- Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy.
| | - Daniela Viscardi
- Department of Anesthesia and Resuscitation, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Luigi Giugliano
- Department of Advanced Biomedical Sciences, "Federico II" University Hospital, Naples, Italy
| | - Luigi Barbuto
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Gaspare Oliva
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Roberto Ronza
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Antonio Borzelli
- Department of Vascular and Interventional Radiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Antonio Raucci
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Filomena Pezzullo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | | | - Luigia Romano
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
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Bilateral adrenal hemorrhage after colectomy for perforated diverticulitis: A case report. Int J Surg Case Rep 2020; 78:336-339. [PMID: 33388513 PMCID: PMC7787958 DOI: 10.1016/j.ijscr.2020.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/21/2022] Open
Abstract
Bilateral adrenal hemorrhage is a rare complication associated with major insult, associated with sepsis and coagulopathy. Postoperative bilateral adrenal hemorrhage could be lifethreatening and its essential to have high level of suspicion. The diagnosis for bilateral adrenal hemorrhage is based on biochemical testing and cross-sectional imaging. Treatment is with steroid replacement which could be temporary or permanent.
Introduction Bilateral adrenal hemorrhage can lead to acute adrenal insufficiency. This is a rare complication in the post-operative setting, and we present a case in which it developed after a colectomy for perforated diverticulitis. Presentation of case The patient is a 65-year-old female who presented with abdominal pain, nausea, emesis, and hematochezia, and CT scan showing sigmoid diverticulitis with peri-sigmoid abscess. After a failure of non-operative treatment, she underwent Hartmann’s resection, and her post-operative course was complicated by refractory tachycardia, hypotension, hyponatremia, and nausea/vomiting. Bleeding, hypovolemia, and sepsis were ruled out. A CT scan showed enlarged poorly defined adrenals bilaterally, suggestive of bilateral adrenal hemorrhage. Serum cortisol level was low and diagnostic of acute adrenal insufficiency. With intravenous steroid therapy (hydrocortisone), her vital signs, laboratory abnormalities, and diet intolerance all resolved. She was discharged on oral prednisone and continued long term. Discussion Bilateral adrenal hemorrhage is rare post-operatively and can lead to adrenal insufficiency. 15% of patients who die in shock have bilateral adrenal hemorrhage on autopsy, indicating the necessity of timely diagnosis and treatment of this condition. Corticosteroid therapy is the mainstay of treatment. Conclusion This case study illustrates that post-operative delay of progression or worsening of condition, with no alternative explanation, can be due to acute adrenal insufficiency resulting from bilateral adrenal hemorrhage, and timely diagnosis and treatment of this condition is paramount for a favorable outcome.
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9
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Lockhart KR, Maré A, Tiu A. Acute adrenal insufficiency secondary to spontaneous bilateral adrenal haemorrhage following salvage cystectomy. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820961735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Anton Maré
- Hunter New England Local Health District, Australia
| | - Albert Tiu
- Hunter New England Local Health District, Australia
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Álvarez-Troncoso J, Zapatero Larrauri M, Montero Vega MD, Gil Vallano R, Palmier Peláez E, Martín Rojas-Marcos P, Martín-Luengo F, Lázaro Del Campo P, Herrero Gil CR, Trigo Esteban E. Case Report: COVID-19 with Bilateral Adrenal Hemorrhage. Am J Trop Med Hyg 2020; 103:1156-1157. [PMID: 32682452 PMCID: PMC7470557 DOI: 10.4269/ajtmh.20-0722] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A 70-year-old Dominican Republic man presented with lower back pain for 10 days. Fifteen days before pain onset, he had low-grade fever, chills, and asthenia, and 4 days before admission, he had constipation, malaise, generalized weakness, anorexia, nausea, and vomiting. On admission, the patient was afebrile and hypotensive, with a heart rate of 105 and an oxyhemoglobin saturation on room air of 95%. Hyponatremia, lymphopenia, elevated C-reactive protein, and ferritin were observed in complementary tests. Computed tomography (CT) scan showed findings consistent with COVID-19 bilateral bronchopneumonia, and an increase in size and blurring (loss of the Y shape) of both adrenals indicative of acute bilateral adrenal hemorrhage. The patient tested negative by reverse transcription polymerase chain reaction (RT-PCR) of nasopharyngeal swab, yet positive for IgG and IgM by ELISA, suggesting COVID-19 diagnosis.
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Affiliation(s)
| | | | - M Dolores Montero Vega
- Microbiology Department, Head of the Serology, Molecular Biology Laboratory, La Paz University Hospital, Madrid, Spain
| | | | | | | | | | | | | | - Elena Trigo Esteban
- High Level Isolation Unit, Tropical and Travel Medicine National Referral Unit, Clinical COVID-19 Team, La Paz University Hospital, Madrid, Spain.,Internal Medicine Department, La Paz University Hospital, Madrid, Spain
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11
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Spontaneous Adrenal Hemorrhage—a Mixed Bag: 18 Cases from a Single Institution. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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12
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Precocious ischemia preceding bilateral adrenal hemorrhage: A case report. Radiol Case Rep 2020; 15:803-807. [PMID: 32346458 PMCID: PMC7178323 DOI: 10.1016/j.radcr.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/20/2022] Open
Abstract
We present a case of a middle-age male who presented in emergency room with nonspecific abdominal pain. A contrast-enhanced computer tomography (ceCT) scan showed a reduced perfusion of both adrenal glands. The clinical examinations and the laboratory tests were negative for an adrenal pathological process. To reassess the adrenal ischemia, a second ceCT scan was performed 5 days later showing an acute bilateral adrenal hemorrhage. These findings demonstrated that the previous adrenal hypoperfusion represented the prodromal manifestation of a hemorrhagic intraglandular process. This case suggests that adrenal hypoperfusion detected on tomographic imaging dictates a prompt clinical management finalized to strictly monitor the potential evolution towards a more aggressive pathological condition and confirms the pivotal role of imaging in the diagnosis of such uncommon disorder.
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Wang L, Wang XF, Qin YC, Chen J, Shang CH, Sun GF, Li NC. Bilateral adrenal hemorrhage after hip arthroplasty: an initially misdiagnosed case. BMC Urol 2019; 19:106. [PMID: 31684918 PMCID: PMC6829824 DOI: 10.1186/s12894-019-0536-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022] Open
Abstract
Background Bilateral adrenal hemorrhage (BAH) is a rare but potentially catastrophic condition. Its clinical manifestation is often non-specific and sometimes difficult to be diagnosed in time. Case summary A 57-year-old woman, who presented with severe fatigue, nausea and vomiting after left hip arthroplasty due to her femoral neck fracture in a local hospital, was transferred to our medical center. Laboratory results revealed significant hyponatremia, low serum cortisol and elevated serum ACTH. Computed tomography (CT) showed a bilateral adrenal mass, measured 3.6 × 2.7 cm on the left and 3.4 × 2.3 cm on the right. Further magnetic resonance imaging (MRI) confirmed the diagnosis of BAH. The patient was prescribed with oral prednisolone acetate, 5 mg, tid, and her condition improved gradually. Nine months after, the patient was in good condition with 5 mg prednisolone acetate per day. CT revealed a clearly shrunken adrenal mass compared with 9 months ago. Conclusions This case illustrates the difficulty in making the diagnosis of BAH with atypical presentation. Such cases necessitate greater alertness on the part of the clinician and require rapid diagnosis and prompt glucocorticoid replacement for better clinical outcomes.
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Affiliation(s)
- Lei Wang
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Health Science Center, Beijing, 100144, China
| | - Xiao-Fei Wang
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Health Science Center, Beijing, 100144, China
| | - Ying-Chao Qin
- Department of General Surgery, Shuangqiao Hospital in Chaoyang District, Beijing, 100024, China
| | - Jia Chen
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Health Science Center, Beijing, 100144, China
| | - Cun-Hai Shang
- Department of Medical Imaging, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China
| | - Guo-Feng Sun
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Health Science Center, Beijing, 100144, China
| | - Ning-Chen Li
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China. .,Peking University Wu Jieping Urology Center, Peking University Health Science Center, Beijing, 100144, China. .,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, 9# Jinyuanzhuang Road, Shijingshan District, Beijing, 100144, China.
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14
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Alidoost M, Soomro R, Gubeladze A, Morabia A, Holland S, Asif A, Hossain MA. Rivaroxaban Related Bilateral Adrenal Hemorrhage: A Rare Complications of Direct Oral Anticoagulants - A Case Reports. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1607-1611. [PMID: 31676747 PMCID: PMC6849691 DOI: 10.12659/ajcr.917780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/13/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Adrenal hemorrhage is an uncommon and under-recognized disorder with a wide array of etiologies ranging from pregnancy to septic shock. It is one of the complications of anticoagulation therapy, including direct anticoagulant medications. CASE REPORT Here, we present a case of a 68-year-old female with recent right knee arthroplasty who was on rivaroxaban for deep vein thrombosis (DVT) prophylaxis presented to the emergency department (ED) for severe acute onset abdominal pain, computed tomography (CT) of abdomen and pelvis revealed possible left adrenal hemorrhage that was confirmed with magnetic resonance imaging (MRI). On repeat CT, her unilateral adrenal hemorrhage converted to a bilateral adrenal hemorrhage (BAH) and, as a result, the patient developed adrenal insufficiency. CONCLUSIONS An undiagnosed and untreated adrenal hemorrhage can have catastrophic consequences, leading to adrenal insufficiency with potential shock and death. Therefore, it is important for clinicians to have an increased awareness and knowledge about adrenal hemorrhage.
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Abstract
RATIONAL Spontaneous adrenal hematoma in pregnancy is a very rare condition. Herein we present an additional rare case of unilateral spontaneous adrenal hematoma in a pregnant woman, aiming to share this experience and summarize the signal characteristics of simple adrenal hematoma in magnetic resonance imaging (MRI). PATIENT CONCERNS A 28-year old pregnant woman was referred to our hospital with a vague paroxysmal left-side back pain at 17 weeks of gestation. DIAGNOSIS MR scan of the abdomen revealed an 8.1 × 7.7 × 6.8 cm round mass in the left adrenal region, which showed a rim of acute hemorrhage signal. Due to the stable condition of the patient and fetus, she was admitted for observation. Repeat MR scan was performed a month later, and it showed a stable mass with marginal subacute bleeding signal. INTERVENTIONS Laparoscope excision of the hematoma was performed. OUTCOMES Simple adrenal hematoma was confirmed by pathological examinations. And the patient was discharged 3 days later with normal renal and adrenal functions. LESSONS The most important characteristic of adrenal hematoma is the high-signal rim on T1-weighted MR images, and the clinicians should make individualized treatment plan for every patient encountered in the future who might have different clinical conditions.
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Affiliation(s)
| | - Yu-Chun Zhu
- Department of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
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Fatima Z, Tariq U, Khan A, Sohail MS, Sheikh AB, Bhatti SI, Munawar K. A Rare Case of Bilateral Adrenal Hemorrhage. Cureus 2018; 10:e2830. [PMID: 30131923 PMCID: PMC6101466 DOI: 10.7759/cureus.2830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bilateral adrenal hemorrhage (BAH) is a rare but potentially fatal entity that carries a mortality rate of 15%. Most cases are associated with sepsis, antiphospholipid syndrome, the use of anticoagulants, as well as trauma and surgery. In this case report, we present a case of BAH in a previously healthy man with a recent history of corticosteroid use. Our case emphasizes the ambiguous clinical presentation of BAH, which poses a challenge in the establishment of a correct diagnosis. We also illustrate the pathophysiology, diagnosis, and subsequent therapeutic approach to this rare clinical entity.
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Affiliation(s)
- Zainab Fatima
- Medicine, Shifa International Hospital, Islamabad, PAK
| | - Usman Tariq
- Research Assistant, Yale University School of Medicine, New Haven, USA
| | - Amina Khan
- Shifa Tameer E Millat University, Shifa International Hospital, Islamabad, PAK
| | | | | | | | - Kamran Munawar
- Internal Medicine, Shifa College of Medicine, Islamabad, PAK
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