Adrenal insufficiency in a patient with severe hypotension caused by bilateral adrenal hemorrhage.
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.
Runer
Evelyn R
ER
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.
Brennan
J Robert
JR
Osterman
Juraj
J
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
D000450:Aldosterone; D019314:Dehydroepiandrosterone Sulfate; D000324:Adrenocorticotropic Hormone; D012083:Renin; D006854:Hydrocortisone