Adrenal Insufficiency From Bilateral Adrenal Hemorrhage

Abstract

Bilateral adrenal hemorrhage is a rare cause of adrenal insufficiency in adults. Because of the nonspecific manifestations of adrenal insufficiency, antemortem diagnosis is difficult. Serial computed tomographic scans of the abdomen are a valuable adjunct in confirming the diagnosis of bilateral adrenal hemorrhage, which manifests as round or oval adrenal masses of high density that subsequently decrease in both size and density. The diagnosis should be suspected in any complex highly stressful illness, in the postoperative period, or in the presence of a coagulopathy in conjunction with hypotension, fever, or electrolyte disturbances. Herein we describe five patients in whom the computed tomographic scans suggested or confirmed the presence of bilateral adrenal hemorrhage. In three of the five patients, the presence of a circulating lupus anticoagulant was demonstrated. Once the diagnosis of adrenal hemorrhage is suspected, steroid replacement therapy should be initiated promptly.

Antiphospholipid syndrome, adrenal failure, dilated cardiomyopathy and chronic hepatitis: an unusual manifestation of multiorgan autoimmune injury?

“…Both adrenals appeared moderately dysmorphic, containing annular calcifications with central hypodensities (Fig. 1), features consistent with previous bilateral haemorrhage (8,9). The patient had always had normal function of the remaining endocrine glands, and other endocrine organ-specific autoantibodies were never detected.…”

“…This would not be consistent with a haemorrhagic etiopathogenesis of the adrenal failure. Adrenal haemorrhage manifests itself as a round or oval adrenal mass that decreases in both size and CT density with time (8,9,11). However, the sensitivity of ultrasound and CT to detect adrenal masses is reported to be 87% and 93% respectively, and a close correlation is also found between the sizes measured by both imaging procedures (12,13).…”

Bilateral adrenal haemorrhage secondary to intra-abdominal sepsis: a case report

“…The adrenal gland receives a rich blood supply from the aorta and the inferior phrenic and adrenal arteries, which form a subcapsular plexus. Necrosis and haemorrhage may occur during hypotension and stress as a result of ischemia or during adrenal stimulation from vascular engorgement and stasis [6][7][8]. Ligation of the right adrenal vein during orthotopic liver transplantation is a recognised cause of adrenal infarction leading to haemorrhage [9].…”

Adrenal Insufficiency

“…Adrenal hemorrhage or infarction occurs in patients who are severely ill from underlying conditions, including sepsis, pulmonary embolism, acute renal failure, acute myocardial infarction, and heart failure. 15,16 The presence of antiphospholipid antibodies or pharmacological anticoagulation can lead to adrenal hemorrhage or infarction. 17 Patients with slow onset AI usually complain of being chronically fatigued.…”