Adrenal insufficiency after adrenal hemorrhage

Abstract

Acute adrenal hemorrhage (AAH) is an extremely rare disorder, especially in adults, and may be difficult to diagnose because of its nonspecific presentation. We report a case of AAH following a sepsis, resulting in persistant adrenal insufficiency contrasting with the radiologic normalisation of the adrenals on computed tomography (CT) scan imaging.

Relative Adrenal Insufficiency in Dogs with Sepsis

“…The pathophysiology of RAI is unknown, but it might be related to suppression of the HPA axis by cytokines such as tumor necrosis factor or interleukin-6, corticostatic substances circulating in sepsis, or adrenal microvascular thrombi and hemorrhage because of disseminated intravascular coagulation. [26][27][28][29][30][31][32] It has been proposed that RAI is associated with hypotension in people because cortisol is required for catecholamine production and proper adrenergic receptor function. 33,34 Why septic people with RAI have poor vascular responsiveness although some cortisol is circulating is unknown.…”

Controversies surrounding critical illness‐related corticosteroid insufficiency in animals

“…It is also unknown whether different mechanisms may be at play in different species, as very limited to no data regarding appropriate corticosteroid metabolism are available in veterinary species. The hypothalamus, pituitary, or adrenal glands may be inhibited or damaged by cytokines, reactive oxygen species, hemorrhage, or other deleterious events during septic shock, leading to inadequate cortisol production or inadequate response to administered ACTH. Plasma CBG is damaged by neutrophil elastase; therefore, during systemic inflammatory states, an increased fraction of total plasma cortisol is in its active form .…”

Graves’ Disease

“…In the elderly, as mentioned, we are able to find apathetic hyperthyroidism, during which the classic manifestations of GD are usually absent, with predominance of cardiac symptoms. Thus, GD should be considered in any patient with atrial fibrillation or heart failure without apparent cause and/or refractory to the standard treatment [1,36,37]. GD should also be considered in cases of amenorrhea or infertility, since some young women may present these problems as a manifestation hyperthyroidism.…”

“…Such paralysis is typically resolvable spontaneous, are often the initial manifestation of hyperthyroidism and may be treated by potassium supplementation and use of beta-blockers. It's cured by the right treatment of hyperthyroidism [1,36,37].…”

“…Nonetheless, a divided dose could also be more effective initially within the most severe cases. Compared to PTU, MMI makes it possible to get euthyroidism more frequently and faster, additionally being better tolerated and causing less hepatotoxicity [36,41,42]. The current guidelines of the American Thyroid Association and also the latest consensus of the Brazilian Society of Endocrinology and Metabology recommends that you must always choose MMI as the first option.…”