title: Post-operative bilateral adrenal haemorrhage: A case report.
abstract: BACKGROUND
  Bilateral adrenal haemorrhage is a rare, but serious, illness carrying an estimated 15% mortality.(1,2) The majority of cases occur in patients with acute, stressful illness, however the exact mechanism underlying adrenal haemorrhage remains unclear. This medical emergency carries significant diagnostic difficulty(4) with non-specific clinical symptoms and variations in electrolyte abnormalities. Timely treatment is important as it prevents both the acute and long-term sequelae of adrenal failure.
  
  
  METHODS
  This report describes a medical emergency in a surgical patient following emergency surgery for intra-abdominal sepsis. The patient reported non-specific symptoms of confusion, mild pyrexia and vague abdominal pain during the post-operative phase, with subtle electrolyte abnormalities and a low serum cortisol suggestive of adrenal crisis. Timely medical treatment, with intravenous hydrocortisone and intensive monitoring, and appropriate medical follow-up with addition of long-term fludrocortisone resulted in a satisfactory outcome.
  
  
  CONCLUSIONS
  This report describes a potentially life-threatening complication of intra-abdominal sepsis with adrenal crisis secondary to bilateral adrenal haemorrhage. In particular, this case highlights the diagnostic difficulty in such surgical patients due to vague symptoms and, in this case, the presence of a presentation variant with acute hyponatraemia and normal potassium.
  
  
  CONCLUSIONS
  This case highlights the importance of awareness of both the symptoms and signs and variation in electrolyte profile when assessing surgical patients post-operatively. In addition, this case highlights the benefit of early recognition and initiation of treatment and the importance of follow-up as long-term medical management is often required to prevent further relapse.
authors.affiliation: Department of General Surgery, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom.
authors.forename: R E
authors.initials: RE
authors.lastname: McNicol
authors.affiliation: Department of General Surgery, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Bradley
authors.affiliation: Department of General Surgery, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Griffin
authors.affiliation: Department of Radiology, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Duncan
authors.affiliation: Department of General Surgery, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom.
authors.forename: C A
authors.initials: CA
authors.lastname: Eriksen
authors.affiliation: Department of General Surgery, Perth Royal Infirmary, Taymount Terrace, Perth PH1 1NX, United Kingdom. Electronic address: graemeguthrie@doctors.org.uk.
authors.forename: G J K
authors.initials: GJ
authors.lastname: Guthrie
keywords: Adrenal haemorrhage; Bilateral; Post-operative