Acute adrenal insufficiency following arthroplasty: a case report and review of the literature

Abstract

BackgroundAcute 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.Case presentationA 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.ConclusionPostoperative 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.

Acute adrenal insufficiency as a mysterious cause of shock following percutaneous coronary intervention: a cardiologist’s nightmare

“…Adrenal shock has been described after orthopaedic, gastroenteric, vascular, intracranial, urologic and CABG surgery 13 14. Acute adrenal insufficiency has not been described after PCI to the best of our knowledge.…”

Hemorragia adrenal bilateral sin insuficiencia adrenal asociada con enoxaparina.

“…En otra publicación, Mandanas et al (10) hacen una revisión de la literatura y encuentran 36 casos reportados de HAB en el posoperatorio. Encontraron 21 asociados con cirugía ortopédica y los 15 restantes a otro tipo de intervención.…”

“…Fuente: tomado y modificado de Rao RH et al (12) Confirmar en la autopsia la causa subyacente. Este reporte se suma a otros más en la literatura (7,10,14) que evidencian la asociación entre el uso de HBPM y la HAB. En ese sentido, se requieren estudios que puedan definir o descartar una asociación causal entre estas dos entidades, teniendo en cuenta el uso frecuente de las heparinas de bajo peso molecular en la práctica diaria y la poco común, pero catastrófica, presentación de la hemorragia adrenal bilateral.…”

Bilateral adrenal hemorrhage after hip arthroplasty: an initially misdiagnosed case

“…BAH after surgery is extremely rare. Mandanas S [9] had reviewed 36 such cases in the year of 2013. Herein, we made a further literature search and 12 additional cases published after the year of 2013 were summarized in Table 1 [6, 8–16].…”