CT diagnosis of acute adrenal insufficiency due to bilateral adrenal haemorrhage

Lykissas, Marios G.; Galanis, Stamatios Harilaos; Borodimos, Athanasios Christoforos; Pakos, Sotirios Georgios

doi:10.1016/j.ejrex.2005.10.013

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…This delay may explain the CT appearance of the adrenals, which was not typical of a hemorrhage [3], though the hyperdense central area could be due to the outbreak where the greatest concentrations of hemoglobin were localized.…”

Section: Discussionmentioning

confidence: 99%

Acute Primary Adrenal Insufficiency after Hip Replacement in a Patient with Acute Intermittent Porphyria

Latina¹,

Terzolo

Pia

et al. 2018

Case Reports in Endocrinology

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Adrenal insufficiency is a potentially life-threatening condition when it occurs acutely, as in adrenal hemorrhage. Generally it is not reversible and requires chronic replacement therapy. Acute intermittent porphyria (AIP) is a rare genetic disease characterized by alterations in heme biosynthesis that result in accumulation of precursors in tissues. A crisis can be triggered by many conditions such as surgery and infections. Symptoms are similar to those of acute hypoadrenalism. Moreover, both conditions are characterized by hyponatremia. We describe the case of a postmenopausal woman known to be affected by AIP who developed after surgery a primary adrenal insufficiency associated with adrenal enlargement; the latter completely reverted in six months.

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Section: Discussionmentioning

confidence: 99%

Acute Primary Adrenal Insufficiency after Hip Replacement in a Patient with Acute Intermittent Porphyria

Latina¹,

Terzolo

Pia

et al. 2018

Case Reports in Endocrinology

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“…Necrosis and hemorrhage may occur during hypotension and stress as a result of ischemia or during adrenal stimulation from vascular engorgement and stasis (11,14,15). Further, platelet aggregation followed by venous thrombosis, vasoconstriction, disruption of the vascular endothelium and regional hypotension can also lead to hemorrhage (16,11). These factors are major contributors to the pathogenesis of adrenal hemorrhage, all of which lead to intramedullary ischemia and bleeding ensues with reperfusion of these damaged vessels.…”

Section: Discussionmentioning

confidence: 99%

A Case of Spontaneous Regression of Idiopathic Bilateral Adrenal Hemorrhage in a Middle Aged Woman: 1 Year Follow-up

Song

Park

et al. 2016

Acta Endo (Buc)

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Background. Bilateral adrenal hemorrhage is a serious condition that can result in adrenal insufficiency, shock, acute adrenal crisis, and mortality if it is not managed with adequate treatment. We report a rare case of idiopathic bilateral adrenal hemorrhage.Case presentation. A 50-year-old woman visited our hospital with complaints of right upper abdominal pain. A computed tomography (CT) revealed unilateral left adrenal gland hemorrhage. However, the results of rapid adrenocorticotropic hormone (ACTH) stimulation test and adrenomedullary hormone function test were normal. Since the patient did not show signs of adrenal insufficiency, corticosteroid therapy was postponed and only supportive management therapy was started. After 1 week, a followup CT showed a previously unseen adrenal hemorrhage on the right adrenal gland, but the rapid ACTH stimulation test result was normal. One year later, no hemorrhagic signs were observed on the follow-up CT. Conclusion.In most cases of idiopathic bilateral adrenal hemorrhage, patients are treated with steroid replacement therapy due to adrenal insufficiency. In some other cases, patients are treated with steroids despite the absence of adrenal insufficiency. Here we reported a very rare case of idiopathic bilateral adrenal hemorrhage sequentially to emphasize that before initiation of adrenal hormone replacement therapy, it is important to determine whether adrenal insufficiency is present. If there is no evidence of adrenal insufficiency, adrenal replacement therapy should be postponed until the presence of adrenal insufficiency is confirmed.

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“…Platelet aggregation followed by venous thrombosis, vasoconstriction, disruption of the vascular endothelium and regional hypotension are major contributors to the pathogenesis of adrenal haemorrhage, all of which lead to intramedullary ischaemia. Bleeding ensues with reperfusion of these damaged vessels [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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

Egan

Larkin

Ryan

et al. 2009

Cases J

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IntroductionBilateral adrenal haemorrhage is a rare cause of adrenal failure. Clinical features are non-specific and therefore a high index of suspicion must be maintained in patients at risk. Predisposing factors include infection, malignancy and the post-operative state.Case presentationWe report the case of a patient who underwent a left hemicolectomy with primary anastomosis and formation of a defunctioning loop ileostomy for an obstructing colon carcinoma at the splenic flexure. En-bloc splenectomy was performed to ensure an oncologic resection. The patient developed a purulent abdominal collection post-operatively and became septic with hypotension and pyrexia. This precipitated acute bilateral adrenal haemorrhage with consequent adrenal insufficiency. Clinical suspicion was confirmed by radiological findings and a co-syntropin test. Following drainage of the collection, antibiotic therapy and corticosteroid replacement, the patient made an excellent recovery.ConclusionThis case highlights the importance of prompt diagnosis and treatment of adrenal failure. In their absence, this condition can rapidly lead to death of the patient.

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CT diagnosis of acute adrenal insufficiency due to bilateral adrenal haemorrhage

Cited by 3 publications

References 9 publications

Acute Primary Adrenal Insufficiency after Hip Replacement in a Patient with Acute Intermittent Porphyria

Acute Primary Adrenal Insufficiency after Hip Replacement in a Patient with Acute Intermittent Porphyria

A Case of Spontaneous Regression of Idiopathic Bilateral Adrenal Hemorrhage in a Middle Aged Woman: 1 Year Follow-up

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

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