title: Adrenal insufficiency in a patient with severe hypotension caused by bilateral adrenal hemorrhage.
abstract: OBJECTIVE
  To describe a patient with adrenal insufficiency and bilateral adrenal enlargement and to review causes of adrenal insufficiency, with special emphasis on adrenal hemorrhage.
  
  
  METHODS
  We present the clinical course of a woman with apparent septic shock, who responded poorly to treatment with inotropic agents. The possible cause and management of such cases are discussed.
  
  
  RESULTS
  A 44-year-old woman with no prior major illness required medical attention because of severe hypotension, volume depletion, acute renal failure, and shock. Numerous laboratory and radiologic studies were performed to determine the cause of her shock state. She did not respond to several inotropic agents. When she was found to have adrenal insufficiency, initiation of treatment with glucocorticoids promptly alleviated her hypotension.
  
  
  CONCLUSIONS
  Critically ill patients who have sudden unexplained hypotension that does not respond to supportive management should be screened for adrenal insufficiency. The current patient emphasizes the importance of considering this disorder in the differential diagnosis of hypotension that is unresponsive to pressor agents.
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, University of South Carolina School of Medicine, Dorn Veterans Affairs Medical Center, Medical Service, Columbia, SC 29208, USA.
authors.forename: Evelyn R
authors.initials: ER
authors.lastname: Runer
authors.forename: J Robert
authors.initials: JR
authors.lastname: Brennan
authors.forename: Juraj
authors.initials: J
authors.lastname: Osterman
mesh_terms: D000307:Adrenal Gland Diseases / Q000150:complications* / Q000175:diagnosis; D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000473:pathology; D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000450:Aldosterone / Q000097:blood; D001706:Biopsy; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006470:Hemorrhage / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000627:therapeutic use; D007022:Hypotension / Q000150:complications*; D012083:Renin / Q000097:blood; D012772:Shock, Septic; D014057:Tomography, X-Ray Computed
chemical_list: D000450:Aldosterone; D019314:Dehydroepiandrosterone Sulfate; D000324:Adrenocorticotropic Hormone; D012083:Renin; D006854:Hydrocortisone