A Rare Case of Bilateral Adrenal Hemorrhage

Fatima, Zainab; Tariq, Usman; Khan, Amina; Sohail, Muhammad Saad; Sheikh, Abu Baker; Munawar, Khalid

doi:10.7759/cureus.2830

Cited by 10 publications

(20 citation statements)

References 10 publications

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“…Long-standing uncontrolled congenital adrenal hyperplasia and macronodular hyperplasia are endocrine disorders that can present as bilateral adrenal masses [10]. Bilateral adrenal hemorrhage should be considered especially in the setting of trauma, sepsis with vasopressor usage, antiphospholipid syndrome, and the use of anticoagulants [11].…”

Section: Discussionmentioning

confidence: 99%

Metastatic Small-Cell Lung Cancer Presenting as Primary Adrenal Insufficiency

Esperti¹,

Stoelting²,

Scibelli³

et al. 2020

Case Reports in Oncological Medicine

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A 40-year-old male smoker with HIV was admitted for cough, hypotension, and abdominal pain for 5 days. Chest radiography showed a right lower lobe consolidation. CT of the chest, abdomen, and pelvis revealed paratracheal adenopathy, a 5.8×4.5 cm mass invading the right bronchus intermedius, and dense bilateral adrenal masses, measuring 5.4×4.0 cm on the right and 4.8×2.0 cm on the left. Laboratory studies showed white blood cell count of 18.5 K/mm3, sodium of 131 mmol/L, creatinine of 1.6 mg/dL, and CD4 count of 567 cells/mm3. The random morning cortisol level was 7.0 μg/dL, the ACTH stimulation test yielded inappropriate response, and a random serum ACTH was elevated at 83.4 pg/mL. MRI brain revealed no pituitary adenoma confirming primary adrenal insufficiency. The adrenal CT washout study was consistent with solid mass content, concerning for metastasis. Bronchoscopy with endobronchial mass and paratracheal lymph node biopsy confirmed small-cell lung cancer (SCLC). Intravenous steroids, 100 mg hydrocortisone every 8 hours, improved his hypotension and abdominal pain. PET scan revealed metabolically active right paratracheal mass, right hilar mass, and bilateral adrenal masses. Treatment included palliative chemotherapy consisting of carboplatin/etoposide/atezolizumab and chest radiation. We present this novel case to demonstrate SCLC’s ability to cause primary adrenal insufficiency, as well as evaluate clinical response to chemotherapeutics.

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Section: Discussionmentioning

confidence: 99%

Metastatic Small-Cell Lung Cancer Presenting as Primary Adrenal Insufficiency

Esperti¹,

Stoelting²,

Scibelli³

et al. 2020

Case Reports in Oncological Medicine

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“…The WFS is a rare disease and mostly fatal, and it occurs acutely in most cases [3][4][5][6][7][8][9]. It is mainly diagnosed at post-mortem; thus, the need for a high index of suspicion and urgent intervention is required.…”

Section: Epidemiology and Aetiologymentioning

confidence: 99%

“…ADH causes water absorption by the kidneys leading to dilutional hyponatraemia. ADH is secreted in response to low blood pressure and low cardiac output and also cortisol is a physiologic inhibitor of ADH [1][2][3][4][5][6][7][8].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Urine osmolality of 463 mOsm/kg, blood osmolality of 253 mOsm/kg, and urine sodium of 13 mmol/L were consistent with adrenal insufficiency except for the low urine sodium. In classical adrenal insufficiency, serum osmolality is less than 280 mOsm/kg, urine osmolality is greater than 100 mOsm/kg, and urine sodium is greater than 20 mmol/L [1][2][3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Investigationsmentioning

confidence: 99%

“…There is a significant role for imaging investigations, especially the CT that diagnosed the bilateral adrenal haemorrhage in this case. If there is suspicion for bilateral adrenal haemorrhage, a CT of the abdomen must be done as soon as possible [3][4][5][6][7][8][9][10][11][12][13][14]. Common findings on CT are masses of variant sizes to clear haemorrhages distorting adrenal architecture.…”

Section: Investigationsmentioning

confidence: 99%

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A Rare Case of Waterhouse-Friderichsen Syndrome Without Purpura Secondary to Haemophilus Influenzae

Chiwome¹

2020

Cureus

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The Waterhouse-Friderichsen syndrome is an entity consisting of shock, petechial rash and haemorrhages in both adrenal glands leading to adrenal failure. This syndrome is usually secondary to meningococcal septicaemia, but there are many documented cases caused by other bacteria. Purpura is an essential part of the syndrome, but it is not always there. In the current study, a case of Waterhouse-Friderichsen syndrome without purpura in an elderly patient with Haemophilus influenzae bacteraemia has been described. This patient was being managed for sepsis due to pneumonia and an incidental finding of bilateral adrenal haemorrhage was made on a CT of the thorax which was meant to evaluate empyema. This case shows the need to suspect bilateral adrenal haemorrhage in every patient with septic shock.

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