title: Acute adrenal insufficiency following arthroplasty: a case report and review of the literature.
abstract: BACKGROUND
  Acute adrenal insufficiency is a potentially lethal condition rarely caused by bilateral adrenal haemorrhage due to heparin use. Most of the times, it is difficult to establish the diagnosis, as symptoms are not specific. Few cases have been reported in the literature.
  
  
  METHODS
  A 52-year-old Caucasian woman presented with abdominal pain, vomiting and weakness nine days after arthroplasty and heparin use. Hyperkalemia, low cortisol and high adrenocorticotropic hormone levels were found, indicating adrenal insufficiency. Magnetic resonance imaging of the upper abdomen was compatible with preceding adrenal haemorrhage. Hydrocortisone and fludrocortisone were administered. Review of the literature revealed 36 cases of postoperative adrenal haemorrhage which are presented briefly.
  
  
  CONCLUSIONS
  Postoperative acute adrenal insufficiency due to haemorrhage is a rare condition. If patients are treated based on clinical suspicion, they have good chances to survive. Hydrocortisone is given permanently in the majority of the patients.
authors.affiliation: Department of Endocrinology, Theagenion Cancer Hospital, Al, Simeonidi st, Thessaloniki 54007, Greece. kpazaitoupanayiotou@gmail.com.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Mandanas
authors.forename: Maria
authors.initials: M
authors.lastname: Boudina
authors.forename: Alexandra
authors.initials: A
authors.lastname: Chrisoulidou
authors.forename: Katerina
authors.initials: K
authors.lastname: Xinou
authors.forename: Efterpi
authors.initials: E
authors.lastname: Margaritidou
authors.forename: Spyros
authors.initials: S
authors.lastname: Gerou
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Pazaitou-Panayiotou
mesh_terms: D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D001178:Arthroplasty / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D005438:Fludrocortisone / Q000627:therapeutic use; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008875:Middle Aged
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin; D005438:Fludrocortisone; D006854:Hydrocortisone
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