Adrenal insufficiency attributable to adrenal hemorrhage: long-term follow-up with reference to glucocorticoid and mineralocorticoid function and replacement.
OBJECTIVE
To describe the long-term follow-up of acute adrenal insufficiency attributable to bilateral adrenal hemorrhage.


METHODS
We performed a retrospective review of medical records of four patients who underwent follow-up for 6(1/2) to 19 years.


RESULTS
Despite published reports of more than 500 patients with bilateral massive adrenal hemorrhage through 2001, no long-term data assessing the continuing requirements for glucocorticoid and mineralocorticoid replacement are available. After follow-up of four patients with acute bilateral adrenal hemorrhage and glucocorticoid insufficiency for 6(1/2) to 19 years, we document the absence of need for long-term mineralocorticoid replacement on the basis of no occurrence of postural hypotension, normal electrolytes, normal baseline or cosyntropin-stimulated serum aldosterone levels, and generally, though not invariably, normal plasma renin activity levels. We further document the improvement in either or both baseline and cosyntropin-stimulated serum cortisol levels in three of the four patients and the ability of one patient to function normally without cortisol replacement for 4 years. Adrenal histologic findings in this last-mentioned patient revealed previously undescribed changes consistent with regeneration and myelolipoma. Finally, we confirm bilateral atrophic adrenal glands by computed tomography 5(1/2) to 11(1/2) years after bilateral adrenal hemorrhage in three of the four patients.


CONCLUSIONS
Long-term follow-up of patients with acute adrenal insufficiency attributable to adrenal hemorrhage demonstrates, for the first time, absence of need for prolonged mineralocorticoid replacement and some improvement in endogenous glucocorticoid function in at least some of these patients.
Jahangir-Hekmat
Maryam
M
Division of Endocrinology, Fairview Hospital System and Cleveland Clinic Health System, Cleveland Clinic, Cleveland, Ohio, USA.
Taylor
Harris C
HC
Levin
Howard
H
Wilbur
Margaret
M
Llerena
Luis A
LA
D000309:Adrenal Insufficiency / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000096:biosynthesis* / Q000627:therapeutic use; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D008901:Mineralocorticoids / Q000096:biosynthesis* / Q000627:therapeutic use; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies
D005938:Glucocorticoids; D008901:Mineralocorticoids