Adrenal insufficiency from bilateral adrenal hemorrhage.
Bilateral adrenal hemorrhage is a rare cause of adrenal insufficiency in adults. Because of the nonspecific manifestations of adrenal insufficiency, antemortem diagnosis is difficult. Serial computed tomographic scans of the abdomen are a valuable adjunct in confirming the diagnosis of bilateral adrenal hemorrhage, which manifests as round or oval adrenal masses of high density that subsequently decrease in both size and density. The diagnosis should be suspected in any complex highly stressful illness, in the postoperative period, or in the presence of a coagulopathy in conjunction with hypotension, fever, or electrolyte disturbances. Herein we describe five patients in whom the computed tomographic scans suggested or confirmed the presence of bilateral adrenal hemorrhage. In three of the five patients, the presence of a circulating lupus anticoagulant was demonstrated. Once the diagnosis of adrenal hemorrhage is suspected, steroid replacement therapy should be initiated promptly.
Siu
S C
SC
Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Kitzman
D W
DW
Sheedy
P F
PF
Northcutt
R C
RC
D000307:Adrenal Gland Diseases / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D000309:Adrenal Insufficiency / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000368:Aged; D001779:Blood Coagulation Factors / Q000032:analysis / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D016682:Lupus Coagulation Inhibitor; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D011241:Prednisone / Q000627:therapeutic use; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D001779:Blood Coagulation Factors; D016682:Lupus Coagulation Inhibitor; D000324:Adrenocorticotropic Hormone; D011241:Prednisone