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Świeczkowski-Feiz S, Toutounchi S, Kaszczewski P, Krajewska E, Celejewski K, Gelo R, Pogorzelski R, Gałązka Z. Characteristics of Adrenal Hemorrhage: A Single Clinic's Experience. POLISH JOURNAL OF SURGERY 2024; 96:36-43. [PMID: 39138988 DOI: 10.5604/01.3001.0054.4570] [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] [Indexed: 08/15/2024]
Abstract
<b>Introduction:</b> Adrenal hemorrhage (AH) is a very rare and potentially life-threatening disease which may be secondary to trauma or of non-traumatic etiology.<b>Aim:</b> The aim of the study was to present the characteristics and management of adrenal hemorrhage and show that adrenal hemorrhage is more common than expected and that the clinical symptoms are not specific.<b>Materials and methods:</b> This retrospective study involved 199 patients with postoperative diagnosis of adrenal hemorrhage.<b>Discussion:</b> The factors identified as potential causes of adrenal hemorrhage are adrenocortical carcinoma, pheochromocytoma, and adrenal adenoma. The study group included 199 patients with postoperative diagnosis of AH. It showed that all patients with postoperative diagnosis had pheochromocytoma (n = 54), adrenal adenoma (n = 68), or adenocarcinoma (n = 17). If we look more careful at the results, we can find only 30% of patients (n = 39) with preoperative diagnosis of AH. This group of 39 patients was prepared for expedited surgery. In this group of patients, the preoperative diagnosis of AH was pheochromocytoma 28% (n = 11), adenocarcinoma (n = 4), and adrenal adenoma (n = 9).<b>Conclusions:</b> Bleeding into adrenal tumors is still an insufficiently understood topic due to its unpredictability and, as can be seen in our material, of varying severity. Out of 199 patients, only 30% (n = 39) were prepared for surgery with a preoperative diagnosis of AH; most of them had pheochromocytoma. We suggest that is very important to prepare patients for surgery with a preoperative diagnosis of AH using α-adrenoreceptor antagonists. Prolongation of the diagnostic process (time between the imaging examination and the surgery) may result in the disease progressing and adrenal bleeding.
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Affiliation(s)
- Siavash Świeczkowski-Feiz
- Department of General, Endocrine and Vascular Surgery, University Clinical Center of the Medical University of Warsaw, Poland
| | - Sadegh Toutounchi
- Department of General, Endocrine and Vascular Surgery, University Clinical Center of the Medical University of Warsaw, Poland
| | - Piotr Kaszczewski
- Department of General, Endocrine and Vascular Surgery, University Clinical Center of the Medical University of Warsaw, Poland
| | - Ewa Krajewska
- Department of General, Endocrine and Vascular Surgery, University Clinical Center of the Medical University of Warsaw, Poland
| | - Krzysztof Celejewski
- Department of General, Endocrine and Vascular Surgery, University Clinical Center of the Medical University of Warsaw, Poland
| | - Remigiusz Gelo
- 2nd Clinic of Anesthesiology and Intensive Care, University Clinical Center of the Medical University of Warsaw, Poland
| | - Ryszard Pogorzelski
- Department of General, Endocrine and Vascular Surgery, University Clinical Center of the Medical University of Warsaw, Poland
| | - Zbigniew Gałązka
- Department of General, Endocrine and Vascular Surgery, University Clinical Center of the Medical University of Warsaw, Poland
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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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3
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Elhassan YS, Ronchi CL, Wijewickrama P, Baldeweg SE. Approach to the Patient With Adrenal Hemorrhage. J Clin Endocrinol Metab 2023; 108:995-1006. [PMID: 36404284 PMCID: PMC9999363 DOI: 10.1210/clinem/dgac672] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022]
Abstract
Adrenal hemorrhage is an uncommon, underrecognized condition that can be encountered in several clinical contexts. Diagnosing adrenal hemorrhage is challenging due to its nonspecific clinical features. Therefore, it remains a diagnosis that is made serendipitously on imaging of acutely unwell patients rather than with prospective clinical suspicion. Adrenal hemorrhage can follow abdominal trauma or appear on a background of predisposing conditions such as adrenal tumors, sepsis, or coagulopathy. Adrenal hemorrhage is also increasingly reported in patients with COVID-19 infection and in the context of vaccine-induced immune thrombocytopenia and thrombosis. Unexplained abdominal pain with hemodynamic instability in a patient with a predisposing condition should alert the physician to the possibility of adrenal hemorrhage. Bilateral adrenal hemorrhage can lead to adrenal insufficiency and potentially fatal adrenal crisis without timely recognition and treatment. In this article, we highlight the clinical circumstances that are associated with higher risk of adrenal hemorrhage, encouraging clinicians to prospectively consider the diagnosis, and we share a diagnostic and management strategy.
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Affiliation(s)
- Yasir S Elhassan
- Correspondence: Yasir Elhassan, MBBS, MRCP, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - Cristina L Ronchi
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TT, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK
- Division of Endocrinology and Diabetes, University Hospital University Würzburg, Würzburg 97080, Germany
| | - Piyumi Wijewickrama
- Department of Diabetes and Endocrinology, University College London Hospital NHS Foundation Trust, London NW1 2BU, UK
| | - Stephanie E Baldeweg
- Department of Diabetes and Endocrinology, University College London Hospital NHS Foundation Trust, London NW1 2BU, UK
- Centre for Obesity and Metabolism, Department of Experimental and Translational Medicine, Division of Medicine, University College London, London WC1E 6BT, UK
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Patousis A, Patousis P, Barbakis G, Sachinis NP. Bilateral Adrenal Hemorrhage Following Femoral Hip Hemiarthroplasty: A Case Report. Cureus 2022; 14:e27748. [PMID: 36106217 PMCID: PMC9447475 DOI: 10.7759/cureus.27748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/05/2022] Open
Abstract
Bilateral adrenal hemorrhage (BAH) is a rare and potentially fatal complication following total hip arthroplasty and low-molecule heparin use for DVT-prophylaxis. We present a case of a 64-year-old woman who sustained a femoral neck fracture, which was addressed with hip hemiarthroplasty. Twelve days postoperatively DVT was diagnosed and therapeutic doses of low-molecule-heparin were administered. The next day, CTPA was done searching for pulmonary embolism but BAH was shown and a short synacthen test confirmed the diagnosis of adrenal insufficiency. A therapeutic protocol with hydrocortisone was followed.
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5
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Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective. J Forensic Leg Med 2022; 89:102355. [DOI: 10.1016/j.jflm.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/23/2022] [Indexed: 12/22/2022]
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6
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Mascolo P, Feola A, Zangani P, Famularo D, Liguori B, Mansueto G, Campobasso CP. Waterhouse Friderichsen Syndrome: Medico-legal issues. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2021. [DOI: 10.1016/j.fsir.2021.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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7
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Cole LP, Hardas A, Priestnall SL, Tinson EW. Waterhouse-Friderichsen syndrome in a cat with Klebsiella spp. infection. J Vet Emerg Crit Care (San Antonio) 2021; 31:531-536. [PMID: 33949088 DOI: 10.1111/vec.13063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/24/2020] [Accepted: 02/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a case of Waterhouse-Friderichsen syndrome of adrenocortical failure in a cat with Klebsiella spp. infection. CASE SUMMARY A 12-year-old male neutered domestic short-haired cat was referred for respiratory failure requiring mechanical ventilation. The cat remained comatose despite successful weaning from the ventilator and developed a Klebsiella pneumoniae pneumonia. On day 4 of hospitalization, the cat acutely deteriorated with profound hypotension, azotemia, and hyperkalemia, which rapidly progressed to cardiac arrest. Necropsy findings revealed massive adrenal hemorrhage and intralesional bacteria, termed Waterhouse-Friderichsen syndrome. Waterhouse-Friderichsen syndrome was suspected to have been the cause of acquired adrenocortical insufficiency and sudden death of the cat. NEW OR UNIQUE INFORMATION To the authors' knowledge, this is the first report of sepsis causing Waterhouse-Friderichsen syndrome in a veterinary species.
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Affiliation(s)
- Laura P Cole
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
| | - Alexandros Hardas
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
| | - Simon L Priestnall
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
| | - Erica W Tinson
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
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Carvalho R, Henriques F, Teixeira S, Coimbra P. Fatal Waterhouse-Friderichsen syndrome in an adult due to serogroup Y Neisseria meningitidis. BMJ Case Rep 2021; 14:14/2/e238670. [PMID: 33541984 PMCID: PMC7868193 DOI: 10.1136/bcr-2020-238670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Waterhouse-Friderichsen syndrome (WFS), defined as severe adrenal insufficiency due to bilateral adrenal gland haemorrhagic necrosis, occurred in a 59-year-old woman. An underlying serogroup Y Neisseria meningitidis (NM) infection was diagnosed, with a rapid progression to purpura fulminans, disseminated intravascular coagulation and WFS. Intensive treatment including fluid resuscitation, broad-spectrum antibiotic therapy, ventilatory support, platelet and factor replacement were administered. The meningococcaemia in the presence of WFS had a fulminant progression, leading to a fatal outcome within 24 hours of symptom onset. This case details the diagnosis and management challenges of the WFS, a rare complication of NM septicaemia, and describes the identification of a NM serogroup that is rare in Portugal in middle-aged patients.
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Affiliation(s)
- Rúben Carvalho
- Department of Infectious Diseases, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Fernando Henriques
- Department of Intensive Care, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Sónia Teixeira
- Department of Intensive Care, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Paulo Coimbra
- Department of Intensive Care, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
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10
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Mulvihill E, Gannon M, Balasubramaniam A, Fitzpatrick J. Bilateral adrenal haemorrhage complicated by sepsis, coagulopathy, influenza A and adrenal crisis. BMJ Case Rep 2020; 13:13/12/e238628. [PMID: 33372021 PMCID: PMC7772329 DOI: 10.1136/bcr-2020-238628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Bilateral adrenal haemorrhage is a rare and often fatal condition that most commonly occurs under conditions of severe physiological stress. We describe a 33-year-old male patient with ulcerative colitis who presented with acute worsening epigastric pain, vomiting and raised inflammatory markers. Initial differentials included gastritis and peptic ulceration. Gastroscopy revealed no abnormalities. By day 3, he had developed sepsis with a sequential organ failure assessment score of 2 as well as coagulopathy. A subsequent CT scan diagnosed bilateral adrenal haemorrhage. A short Synacthen Test confirmed adrenal insufficiency and he was treated with replacement steroids and antibiotics for a possible urinary tract infection or pyelonephritis and he recovered well. Several days later he developed fever, dyspnoea and a productive cough. Subsequently, he became hypotensive (Blood Pressure (BP) 95/65 mm Hg) and unresponsive with a Glasgow Coma Scale of 7 and was hyponatraemic and hyperkalaemic. He was intubated and transferred to a tertiary hospital for intensive care unit management where investigations confirmed the patient to be influenza A positive.
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11
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Chiwome L. A Rare Case of Waterhouse-Friderichsen Syndrome Without Purpura Secondary to Haemophilus Influenzae. Cureus 2020; 12:e9621. [PMID: 32923222 PMCID: PMC7478936 DOI: 10.7759/cureus.9621] [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: 07/17/2020] [Accepted: 08/09/2020] [Indexed: 11/12/2022] Open
Abstract
The Waterhouse-Friderichsen syndrome is an entity consisting of shock, petechial rash and haemorrhages in both adrenal glands leading to adrenal failure. This syndrome is usually secondary to meningococcal septicaemia, but there are many documented cases caused by other bacteria. Purpura is an essential part of the syndrome, but it is not always there. In the current study, a case of Waterhouse-Friderichsen syndrome without purpura in an elderly patient with Haemophilus influenzae bacteraemia has been described. This patient was being managed for sepsis due to pneumonia and an incidental finding of bilateral adrenal haemorrhage was made on a CT of the thorax which was meant to evaluate empyema. This case shows the need to suspect bilateral adrenal haemorrhage in every patient with septic shock.
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Affiliation(s)
- Lawman Chiwome
- General Internal Medicine, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
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12
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Seow YT, Ng ZQ, Wong SL. Anticoagulation-induced unilateral adrenal haemorrhage and pseudoaneurysm. BMJ Case Rep 2019; 12:12/12/e232539. [PMID: 31822535 DOI: 10.1136/bcr-2019-232539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spontaneous unilateral adrenal haemorrhage (AH) is extremely rare. Its presentation is usually non-specific and requires a high degree of suspicion as it is associated with high morbidity and mortality if diagnosis is delayed. Hereby, we present a case of 67-year-old man with significant cardiac history presented with right-sided chest pain and non-specific abdominal pain. He was previously treated for non-ST elevation myocardial infarction 5 days ago prior to the current presentation. CT scan of abdomen and pelvis demonstrated a right-sided active AH. The patient subsequently underwent digital subtraction angiography. Angio-embolisation was attempted for the pseudoaneurysm but failed due to spasm of the vessel. He was managed conservatively and discharged after clinical improvement. Clinic review 6 months later showed significant size reduction of the pseudoaneurysm.
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Affiliation(s)
- Yi Th'ng Seow
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia .,Department of General Surgery, St John of God Midland Public Hospital, Midland, Western Australia, Australia
| | - Zi Qin Ng
- Department of General Surgery, St John of God Midland Public Hospital, Midland, Western Australia, Australia
| | - Sze Ling Wong
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of General Surgery, St John of God Midland Public Hospital, Midland, Western Australia, Australia
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13
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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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The Conundrum of Septic Shock Imitators in Patients with Hematologic Cancers: Case Presentation and Possible Differential Diagnoses. Case Rep Crit Care 2019; 2019:6561018. [PMID: 31583137 PMCID: PMC6754887 DOI: 10.1155/2019/6561018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/04/2019] [Accepted: 07/15/2019] [Indexed: 11/27/2022] Open
Abstract
The authors describe the case of a patient treated with several cycles of chemotherapy due to an advanced stage non-Hodgkin lymphoma. One daafter the last cycle, he was admitted to our Intensive Care Unit with a septic shock-like clinical picture which didn't respond to the aggressive treatment and the patient died a few hours later. The autoptical findings cast some doubts on the diagnosis, and demonstrated the presence of other factors imitating its symptoms. In this article, the mimickers of septic shock are reviewed and discussed, as some of them require an aggressive immunosuppression instead of the recommended treatment for septic shock.
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15
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Kadam SV, Tailor KB, Joshi VH, Rao SG. Preoperative adrenal insufficiency in a neonate with congenital heart disease surgery. Ann Pediatr Cardiol 2019; 12:351-353. [PMID: 31516305 PMCID: PMC6716307 DOI: 10.4103/apc.apc_108_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shankar Vithalrao Kadam
- Department of Pediatric Cardiac Intensive Care, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Kamlesh B Tailor
- Department of Pediatric Cardiac Intensive Care, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Vinay Hk Joshi
- Department of Pediatric Cardiac Intensive Care, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Suresh G Rao
- Department of Pediatric Cardiac Intensive Care, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India. E-mail:
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Ventura Spagnolo E, Mondello C, Roccuzzo S, Stassi C, Cardia L, Grieco A, Raffino C. A unique fatal case of Waterhouse-Friderichsen syndrome caused by Proteus mirabilis in an immunocompetent subject: Case report and literature analysis. Medicine (Baltimore) 2019; 98:e16664. [PMID: 31441842 PMCID: PMC6716737 DOI: 10.1097/md.0000000000016664] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The Waterhouse-Friderichsen syndrome (WFS), also known as purpura fulminans, is a potentially lethal condition described as acute hemorrhagic necrosis of the adrenal glands. It is often caused by infection. Classically, Neisseriae meningitidis represents the main microorganism related to WFS, although, infrequently, also other infectious agents are reported as a possible etiologic agent. The authors report the first case of death due to Proteus mirabilis infection, with postmortem evidence of WFS. PATIENT CONCERNS After a facial trauma that provoked a wound on the nose, the subject, a healthy 40-years old man, was conducted to the local hospital (in Sicily, Italy) after the primary care he was discharged. Subsequently, after 2 days of general malaise, he returned to the hospital due to the worsening of the clinical condition. During the hospitalization, hypotension, and neurological impairment appeared; the laboratory analysis showed leukocytosis and the alteration of renal, hepatic and coagulative parameters. Microbiological blood analysis resulted positive for a P mirabilis infection. DIAGNOSIS Multiorgan failure (MOF) with disseminated intravascular coagulation (DIC) due to sepsis was diagnosed. INTERVENTIONS The practitioners administered intensive support, antibiotic therapy, antithrombin III, vitamin K, and plasma. OUTCOMES After 3 days the subject died. The autopsy and the microscopic investigation were performed revealing, also, the adrenal diffuse micronodular hyperplasia associated with a cortico-medullary hemorrhagic apoplexy. CONCLUSION To our knowledge, this is the first case of MOF with WFS due to P mirabilis infection. This case report suggests that P mirabilis should be added to the list of unusual bacteria causing WFS. Furthermore, it supports the theory that any bacterium which causes DIC may cause adrenal hemorrhage and should suggest to clinicians the importance to consider a potential adrenal involvement in every patient with sepsis and DIC.
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Affiliation(s)
- Elvira Ventura Spagnolo
- Legal Medicine Section – Department for Health Promotion and Mother-Child Care, University of Palermo, Via del Vespro
| | - Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina
| | - Salvatore Roccuzzo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina
| | - Chiara Stassi
- Legal Medicine Section – Department for Health Promotion and Mother-Child Care, University of Palermo, Via del Vespro
| | - Luigi Cardia
- Department of Human Pathology of Adult and Childhood “Gaetano Barresi,” University of Messina, Messina
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Gentile G, Amadasi A, Bailo P, Boracchi M, Maciocco F, Marchesi M, Zoja R. The importance of the postmortem interval for the diagnosis of Waterhouse-Friderichsen syndrome by Neisseria meningitidis in a series of forensic cases. AUTOPSY AND CASE REPORTS 2019; 9:e2019103. [PMID: 31372361 PMCID: PMC6629265 DOI: 10.4322/acr.2019.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/06/2019] [Indexed: 11/23/2022] Open
Abstract
The effective value of microbiological post-mortem examinations stands as fundamental in forensic cases involving microbiology. We ran these analyses on five victims, who suddenly died after showing persistent fever. The examinations were conducted between 48 hours and 10 days after death, and adrenal gland apoplexy was detected in all the cases. Microbiological examinations identified Neisseria meningitidis, which was accountable for Waterhouse–Friderichsen syndrome. Diplococci were isolated from three cadavers that underwent forensic dissection between 2 and 3 days after death. The remaining two cadavers showed polymicrobial contamination, and a polymerase chain reaction technique was necessary to identify the pathogen. We assumed that the microbial overlap could lead to diagnostic mistakes and conceal the identification of the lethal pathogen. Therefore, we suggest using molecular techniques for a postmortem interval (PMI) longer than 72 hours. Classical microbiological examination should be performed for PMI within 72 hours.
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Affiliation(s)
- Guendalina Gentile
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute. Milano, Italy
| | - Alberto Amadasi
- Università degli Studi di Bologna, Facoltà di Medicina e Chirurgia, Sezione di Medicina Legale, Dipartimento di Scienze mediche e Chirurgiche (DIMEC). Bologna, Italy
| | - Paolo Bailo
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute. Milano, Italy
| | - Michele Boracchi
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute. Milano, Italy
| | - Francesca Maciocco
- Ospedale S. Carlo Borromeo, Servizio di Immunoematologia e Medicina Trasfusionale (SIMT). Milano, Italy
| | - Matteo Marchesi
- Ospedale di Bergamo, Azienda Socio Sanitaria Papa Giovanni XXIII, Responsabile USS Medicina Legale. Bergamo, Italy
| | - Riccardo Zoja
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute. Milano, Italy
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19
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Ali A, Singh G, Balasubramanian SP. Acute non-traumatic adrenal haemorrhage-management, pathology and clinical outcomes. Gland Surg 2018; 7:428-432. [PMID: 30505763 DOI: 10.21037/gs.2018.07.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Acute adrenal haemorrhage is a rare medical emergency. The aim of the series was to study the clinical presentation and management of patients presenting with acute non-traumatic adrenal haemorrhage. Methods The records of patients presenting with an acute abdomen secondary to adrenal haemorrhage and treated in a tertiary endocrine surgical unit over a period of 6 years were reviewed. Results Of the 11 included patients, there were 4 males and 7 females; the median [range] age at presentation was 58 [27-89] years. All were initially managed conservatively for bleeding, except one who underwent angioembolisation to ensure hemodynamic stability. Two patients underwent percutaneous drainage of persistent collection and suspected sepsis. Biochemical workup showed hyper function with metanephrine excess in 1 patient. Adrenalectomy was performed in 5 patients after a median [range] of 10 [7-11] weeks. Histology showed benign pathology in 2 patients, malignant in 2 patients and necrotic tumour in 1 patient. Two patients died of disseminated metastatic disease at 5 and 2 months after presentation with bleeding. Conservative management in the other 3 patients was successful at a median follow up of 26 [6-66] months. Conclusions Acute adrenal haemorrhage is usually associated with an underlying pathology; which may be benign or malignant; functional or non-functional. Initial conservative management is preferred as it allows determination of functional status and elective surgery, if necessary.
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Affiliation(s)
- Adibah Ali
- Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gautam Singh
- Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Saba P Balasubramanian
- Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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20
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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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21
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Kato S, Yanazaki M, Hayashi K, Satoh F, Isobe I, Tsutsumi Y. Fulminant group A streptococcal infection without gangrene in the extremities: Analysis of five autopsy cases. Pathol Int 2018; 68:419-424. [PMID: 29722472 DOI: 10.1111/pin.12678] [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: 01/09/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
Five autopsy cases of fulminant group A streptococcal infection without gangrene in the extremities are presented. Clinical course of the fulminant illness was short (2-4 days). One pathological autopsy case was aged (86-years-old), and hemorrhagic cystitis was observed. The other four forensic autopsy cases were young (24-38 years-old) with the mean age of 32, and the primary infective lesions were located in the postpartum endometrium, tonsil and bronchus (2 cases). Systemic coccal dissemination with poor neutrophilic reaction was seen in two of five cases. Bilateral renal cortical necrosis was noted in three cases (including two with bacterial embolism). Hemophagocytosis, probably resulting from hypercytokinemia, was characteristic in three cases without bacterial embolism. Gram-positive cocci colonizing the hemorrhagic and necrotizing lesions were consistently immunoreactive for streptococcal antigens and Strep A (a carbohydrate antigen on group A streptococci). Neutrophilic reaction was mild in the primary infected foci. Clinicians should note that fulminant streptococcal infection (streptococcal toxic shock syndrome) in young and immunocompetent patients may not be associated with gangrene in the extremities. Autopsy prosecutors (diagnostic and forensic pathologists) must recognize the difficulty in making an appropriate autopsy diagnosis, particularly when bacterial embolism is not associated.
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Affiliation(s)
- Shu Kato
- Medical Student, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.,Department of Pathology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Motoi Yanazaki
- Medical Student, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.,Department of Pathology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kino Hayashi
- Tokyo Medical Examiner's Office, Otsuka, Tokyo, Japan
| | - Fumiko Satoh
- Department of Legal Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ichiro Isobe
- Department of Legal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yutaka Tsutsumi
- Department of Pathology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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22
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Nosé V. Infectious Disorders, Adrenal Glands. DIAGNOSTIC PATHOLOGY: ENDOCRINE 2018. [PMCID: PMC7455170 DOI: 10.1016/b978-0-323-52480-3.50079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Pisano SRR, Howard J, Posthaus H, Kovacevic A, Yozova ID. Hydrocortisone therapy in a cat with vasopressor-refractory septic shock and suspected critical illness-related corticosteroid insufficiency. Clin Case Rep 2017; 5:1123-1129. [PMID: 28680609 PMCID: PMC5494402 DOI: 10.1002/ccr3.1018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/05/2017] [Accepted: 05/01/2017] [Indexed: 01/22/2023] Open
Abstract
A 27‐month‐old female cat was presented with septic peritonitis secondary to a ruptured pyometra and subsequent pyothorax. Vasopressor‐refractory septic shock led to a suspicion of critical illness‐related corticosteroid insufficiency, successfully treated with intravenous hydrocortisone. Previous megestrol acetate administration may have played a role in the development of adrenocortical dysfunction.
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Affiliation(s)
- Simone R R Pisano
- Department of Clinical Veterinary Medicine Vetsuisse Faculty University of Bern Bern Switzerland
| | - Judith Howard
- Department of Clinical Veterinary Medicine Vetsuisse Faculty University of Bern Bern Switzerland
| | - Horst Posthaus
- Department of Infectious Diseases and Pathobiology Vetsuisse Faculty University of Bern Bern Switzerland
| | - Alan Kovacevic
- Department of Clinical Veterinary Medicine Vetsuisse Faculty University of Bern Bern Switzerland
| | - Ivayla D Yozova
- Institute of Veterinary, Animal and Biomedical Sciences Massey University Palmerston North New Zealand
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24
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Streptococcus Pneumoniae Detection Long Time After Death in a Fatal Case of Waterhouse-Friderichsen Syndrome. Am J Forensic Med Pathol 2016; 38:18-20. [PMID: 28009598 DOI: 10.1097/paf.0000000000000284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a fatal case of Waterhouse-Friderichsen syndrome in a 64-year-old man. The diagnosis, suspected during the autopsy (performed 63 hours after death), was confirmed through the successful detection of Streptococcus pneumoniae DNA and antigens in samples (blood and liver) collected during the autopsy. These results conformed with blood cultures performed antemortem, which became available only the day after the autopsy. The case underlines the need to collect biological material (liver and blood samples) during autopsy for microbiological investigations, although the collection is performed a long time after the death, suggesting that a liver sample works for DNA and liver and blood work for Streptococcus pneumoniae antigen detection.
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25
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Logaraj A, Tsang VHM, Kabir S, Ip JCY. Adrenal crisis secondary to bilateral adrenal haemorrhage after hemicolectomy. Endocrinol Diabetes Metab Case Rep 2016; 2016:EDM160048. [PMID: 27855238 PMCID: PMC5093400 DOI: 10.1530/edm-16-0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/06/2016] [Indexed: 11/08/2022] Open
Abstract
Adrenal 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.
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Affiliation(s)
- Anthony Logaraj
- Department of Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia; The University of Sydney, Sydney, Australia
| | - Venessa H M Tsang
- The University of Sydney, Sydney, Australia; Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Shahrir Kabir
- Department of Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia; The University of Sydney, Sydney, Australia
| | - Julian C Y Ip
- Department of Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia; The University of Sydney, Sydney, Australia
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26
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Mudenha ET, Rathi M. Adrenal insufficiency due to the development of bilateral adrenal haemorrhage following hip replacement surgery. JRSM Open 2015; 6:2054270415609837. [PMID: 26673817 PMCID: PMC4641559 DOI: 10.1177/2054270415609837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Bilateral adrenal haemorrhage should be considered as a differential diagnosis in patients presenting with non-specific symptoms and hypotension postoperatively.
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Affiliation(s)
- Emily T Mudenha
- Department of Diabetes and Endocrinology, Kings Mill Hospital, Mansfield Road, Sutton-in-Ashfield NG17 4JL, Nottinghamshire, UK
| | - Manjusha Rathi
- Department of Diabetes and Endocrinology, Kings Mill Hospital, Mansfield Road, Sutton-in-Ashfield NG17 4JL, Nottinghamshire, UK
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27
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Chernyak V, Patlas MN, Menias CO, Soto JA, Kielar AZ, Rozenblit AM, Romano L, Katz DS. Traumatic and non-traumatic adrenal emergencies. Emerg Radiol 2015; 22:697-704. [PMID: 26482245 DOI: 10.1007/s10140-015-1357-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022]
Abstract
Multiple traumatic and non-traumatic adrenal emergencies are occasionally encountered during the cross-sectional imaging of emergency department patients. Traumatic adrenal hematomas are markers of severe polytrauma, and can be easily overlooked due to multiple concomitant injuries. Patients with non-traumatic adrenal emergencies usually present to an emergency department with a non-specific clinical picture. The detection and management of adrenal emergencies is based on cross-sectional imaging. Adrenal hemorrhage, adrenal infection, or rupture of adrenal neoplasm require immediate detection to avoid dire consequences. More often however, adrenal emergencies are detected incidentally in patients being investigated for non-specific acute abdominal pain. A high index of suspicion is required for the establishment of timely diagnosis and to avert potentially life-threatening complications. We describe cross-sectional imaging findings in patients with traumatic and non-traumatic adrenal hemorrhage, adrenal infarctions, adrenal infections, and complications of adrenal masses.
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Affiliation(s)
| | - Michael N Patlas
- Division of Emergency/Trauma Radiology, Department of Radiology, McMaster University, Hamilton, ON, Canada. .,Division of Emergency/Trauma Radiology, Department of Radiology, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON, Canada, L8L 2X2.
| | - Christine O Menias
- Department of Radiology, Mayo Clinic School of Medicine, Scottsdale, AZ, USA
| | - Jorge A Soto
- Department of Radiology, Boston University, Boston, MA, USA
| | - Ania Z Kielar
- Division of Abdominal and Pelvic Imaging, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Alla M Rozenblit
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Luigia Romano
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, USA
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28
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McNicol RE, Bradley A, Griffin J, Duncan G, Eriksen CA, Guthrie GJK. Post-operative bilateral adrenal haemorrhage: A case report. Int J Surg Case Rep 2014; 5:1145-7. [PMID: 25437659 PMCID: PMC4275802 DOI: 10.1016/j.ijscr.2014.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/20/2014] [Indexed: 11/29/2022] Open
Abstract
An unusual complication of intra-abdominal sepsis. A demonstration of diagnostic difficulty in the post-operative patient. A variation from the normal electrolyte profile observed in adrenal insufficiency. Highlights the clinical importance of a high index of suspicion for further investigation of ‘on-ward’ electrolyte abnormalities.
INTRODUCTION Bilateral adrenal haemorrhage is a rare, but serious, illness carrying an estimated 15% mortality.1,2 The majority of cases occur in patients with acute, stressful illness, however the exact mechanism underlying adrenal haemorrhage remains unclear. This medical emergency carries significant diagnostic difficulty4 with non-specific clinical symptoms and variations in electrolyte abnormalities. Timely treatment is important as it prevents both the acute and long-term sequelae of adrenal failure. PRESENTATION OF CASE This report describes a medical emergency in a surgical patient following emergency surgery for intra-abdominal sepsis. The patient reported non-specific symptoms of confusion, mild pyrexia and vague abdominal pain during the post-operative phase, with subtle electrolyte abnormalities and a low serum cortisol suggestive of adrenal crisis. Timely medical treatment, with intravenous hydrocortisone and intensive monitoring, and appropriate medical follow-up with addition of long-term fludrocortisone resulted in a satisfactory outcome. DISCUSSION This report describes a potentially life-threatening complication of intra-abdominal sepsis with adrenal crisis secondary to bilateral adrenal haemorrhage. In particular, this case highlights the diagnostic difficulty in such surgical patients due to vague symptoms and, in this case, the presence of a presentation variant with acute hyponatraemia and normal potassium. CONCLUSION This case highlights the importance of awareness of both the symptoms and signs and variation in electrolyte profile when assessing surgical patients post-operatively. In addition, this case highlights the benefit of early recognition and initiation of treatment and the importance of follow-up as long-term medical management is often required to prevent further relapse.
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Affiliation(s)
- R E McNicol
- Department of General Surgery, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom
| | - A Bradley
- Department of General Surgery, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom
| | - J Griffin
- Department of General Surgery, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom
| | - G Duncan
- Department of Radiology, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom
| | - C A Eriksen
- Department of General Surgery, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom
| | - G J K Guthrie
- Department of General Surgery, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom.
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29
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Upadhyay J, Sudhindra P, Abraham G, Trivedi N. Tuberculosis of the adrenal gland: a case report and review of the literature of infections of the adrenal gland. Int J Endocrinol 2014; 2014:876037. [PMID: 25165474 PMCID: PMC4138934 DOI: 10.1155/2014/876037] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 12/14/2022] Open
Abstract
Infections of the adrenal glands remain an important cause of adrenal insufficiency, especially in the developing world. Indeed, when Thomas Addison first described the condition that now bears his name over 150 years ago, the vast majority of cases were attributable to tuberculosis. Here we describe a classic, but relatively uncommon, presentation in the United States of adrenal insufficiency followed by a review of the current literature pertaining to adrenal infections.
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Affiliation(s)
- Jagriti Upadhyay
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01760, USA
- *Jagriti Upadhyay:
| | - Praveen Sudhindra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01760, USA
| | - George Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01760, USA
| | - Nitin Trivedi
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01760, USA
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30
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Wassum JA, Batalis NI. Waterhouse-Friderichsen Syndrome. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. Andrew Wassum
- Pathology and Laboratory Medicine at the Medical University of South Carolina
| | - Nicholas I. Batalis
- Medical University of South Carolina - Pathology and Lab Medicine, Charleston, SC (AW)
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