title: Spontaneous idiopathic bilateral adrenal haemorrhage: a rare cause of abdominal pain.
abstract: We describe a case of a 62-year-old woman with a history of chronic obstructive pulmonary disease and gastro-oesophageal reflux disease who presented to the emergency department with left lower quadrant abdominal pain, flank pain with nausea and no history of preceding trauma. The patient had finished a course of azithromycin and oral methylprednisolone 1 day prior to presentation. Abdominal and pelvic CT scan identified changes suggestive of bilateral adrenal haemorrhage. The patient did not show signs of acute adrenal insufficiency but was started on steroid replacement therapy because of concerns about possible disease progression. All recognised causes of adrenal haemorrhage were excluded suggesting this was a case of spontaneous idiopathic bilateral adrenal haemorrhage, a rarely reported phenomenon in the literature. The patient was discharged after clinical improvement following 6 days in hospital, taking oral steroid replacement.
authors.affiliation: Department of Internal Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.
authors.forename: Salik
authors.initials: S
authors.lastname: Nazir
authors.affiliation: Department of Endocrinology and Metabolism, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.
authors.forename: Surendra
authors.initials: S
authors.lastname: Sivarajah
authors.affiliation: Department of Internal Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.
authors.forename: Valena
authors.initials: V
authors.lastname: Fiscus
authors.affiliation: Department of Internal Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: York
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy / Q000209:etiology*; D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D013256:Steroids / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D013256:Steroids