Bilateral adrenal hemorrhage in a total knee patient associated with enoxaparin usage

Park, Kwan Jun; Bushmiaer, Marty; Barnes, C. Lowry

doi:10.1016/j.artd.2015.02.001

Cited by 9 publications

(18 citation statements)

References 24 publications

(57 reference statements)

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“…Risk factors for adrenal hemorrhage include anticoagulation therapy, corticotropin stimulation, metastatic disease to the adrenal gland, adrenal tumor, trauma, severe sepsis, antiphospholipid syndrome, and recent surgery (4,5,9). The clinical presentation of adrenal hemorrhage is nonspecific and makes establishing the diagnosis a challenge.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, having a high degree of clinical suspicion is important in facilitating an earlier diagnosis to avoid unfavorable outcomes. Signs and symptoms can include back or flank pain, anorexia, nausea, vomiting, hypotension, and fever (3)(4)(5). Adrenal insufficiency from adrenal hemorrhage is more often associated with bilateral adrenal hemorrhage, but in cases of unilateral adrenal hemorrhage it is suspected that the contralateral adrenal gland becomes "exhausted" with decreased or absent cortical lipid resulting in hypocortisolemia (2).…”

Section: Discussionmentioning

confidence: 99%

“…Imaging studies that can identify adrenal hemorrhage include CT, MRI, and ultrasound (5,10,11). Adrenal gland enlargement with signal attenuation greater than that seen with fluid on CT scan is suggestive of adrenal hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…Laboratory findings, if present, are usually consistent with adrenal insufficiency and include hyponatremia, hyperkalemia, hypoglycemia, leukocytosis, acidosis, and azotemia; however, these abnormalities are not always present (1,4,9). A cosyntropin stimulation test can aid in the diagnosis with cortisol measurements at baseline, 30 minutes, and 60 minutes following cosyntropin administration (5).…”

Section: Discussionmentioning

confidence: 99%

“…Historically, the diagnosis had been made in postmortem examinations but the emergence of more sophisticated imaging modalities has allowed for the ability to establish the diagnosis earlier in the clinical course (4). Literature reports of adrenal hemorrhage from the use of anticoagulants has more often been associated with heparin, lowmolecular-weight heparin, and warfarin (5)(6)(7)(8)(9)(10). We present a case of rivaroxaban-induced adrenal hemorrhage with subsequent adrenal insufficiency following total knee arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

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Adrenal Insufficiency from Unilateral Adrenal Hemorrhage in a Patient on Rivaroxaban Thromboprophylaxis

Quintero

2019

AACE Clinical Case Reports

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Objective:We report a case of unilateral adrenal hemorrhage resulting in adrenal insufficiency in a patient on rivaroxaban for thromboprophylaxis after total knee arthroplasty.Methods: The clinical presentation, laboratory findings, and outcome of the case are described. An overview of the etiology, diagnosis, and treatment of adrenal hemorrhage is reviewed.Results: A 61-year-old male underwent bilateral total knee replacements and postoperatively was started on rivaroxaban at 10 mg daily for thromboprophylaxis. About 2 weeks after the procedure, the patient presented with abdominal pain, nausea, vomiting, and generalized weakness. Abdominal computed tomography scan identified an ill-defined heterogeneous density in the left suprarenal fossa, and an abdominal magnetic resonance imaging scan identified diffuse thickening of the left adrenal gland with periadrenal fat stranding suggestive of adrenal hemorrhage. Adrenal insufficiency was suspected and confirmed with a cosyntropin stimulation test. Pre-stimulus cortisol level was 2.7 µg/dL and 60 minutes after cosyntropin administration it was 2.5 µg/dL. The patient was started on intravenous hydrocortisone at 100 mg every 6 hours with improvement of symptoms and discharged on oral hydrocortisone at 20 mg twice daily. Follow up abdominal magnetic resonance imaging 6 weeks after discharge demonstrated resolution of the left adrenal hemorrhage.Conclusion: A high clinical suspicion and early detection of adrenal hemorrhage in a patient on anticoagulation can allow for earlier intervention and improved outcomes. (AACE Clinical Case Rep. 2019;5:e70-e72) Abbreviations: CT = computed tomography; MRI = magnetic resonance imaging

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Adrenal Insufficiency from Unilateral Adrenal Hemorrhage in a Patient on Rivaroxaban Thromboprophylaxis

Quintero

2019

AACE Clinical Case Reports

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Hématomes surrénaliens non traumatiques : série rétrospective de 20 cas

Senni

Gerfaud‐Valentin

Hot

et al. 2021

La Revue de Médecine Interne

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Bilateral adrenal hemorrhage after hip arthroplasty: an initially misdiagnosed case

Wang

Qin

et al. 2019

BMC Urol

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BackgroundBilateral adrenal hemorrhage (BAH) is a rare but potentially catastrophic condition. Its clinical manifestation is often non-specific and sometimes difficult to be diagnosed in time.Case summaryA 57-year-old woman, who presented with severe fatigue, nausea and vomiting after left hip arthroplasty due to her femoral neck fracture in a local hospital, was transferred to our medical center. Laboratory results revealed significant hyponatremia, low serum cortisol and elevated serum ACTH. Computed tomography (CT) showed a bilateral adrenal mass, measured 3.6 × 2.7 cm on the left and 3.4 × 2.3 cm on the right. Further magnetic resonance imaging (MRI) confirmed the diagnosis of BAH. The patient was prescribed with oral prednisolone acetate, 5 mg, tid, and her condition improved gradually. Nine months after, the patient was in good condition with 5 mg prednisolone acetate per day. CT revealed a clearly shrunken adrenal mass compared with 9 months ago.ConclusionsThis case illustrates the difficulty in making the diagnosis of BAH with atypical presentation. Such cases necessitate greater alertness on the part of the clinician and require rapid diagnosis and prompt glucocorticoid replacement for better clinical outcomes.

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Bilateral adrenal hemorrhage in a total knee patient associated with enoxaparin usage

Cited by 9 publications

References 24 publications

Adrenal Insufficiency from Unilateral Adrenal Hemorrhage in a Patient on Rivaroxaban Thromboprophylaxis

Adrenal Insufficiency from Unilateral Adrenal Hemorrhage in a Patient on Rivaroxaban Thromboprophylaxis

Hématomes surrénaliens non traumatiques : série rétrospective de 20 cas

Bilateral adrenal hemorrhage after hip arthroplasty: an initially misdiagnosed case

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