Research Day
A RARE CASE OF BILATERAL SPONTANEOUS ADRENAL HEMORRHAGE
Document Type
Abstract
Date
2021
Abstract
A 57-year-old man with history of peripheral vascular disease presented with acute onset of severe, diffuse, tearing abdominal pain. His pain was radiating to his back and was associated to nausea, vomiting and diarrhea. On presentation, his blood pressure was 216/119 mm of Hg which later dropped to 90/50's. Exam was significant for bluish colored diffuse abdominal rash with diffuse abdominal tenderness. On labs, his hemoglobin dropped from 12.0 to 6.5 on day 3 of hospitalization with creatinine increasing from 0.94 to 1.95, and sodium of 129. Initial CT on arrival showed extensive vaso-occlusive disease in abdomen, but no active bleeding. Repeat CT scan was done when hemoglobin dropped showed new bilateral adrenal nodules measuring 38mm on right and 30mm on left likely representing adrenal hemorrhage and moderate to large peritoneal hemorrhage. His antiphospholipid and HIT screen were negative, so were his blood cultures. TEG scan and platelet mapping showed no coagulopathy. He was started on corticosteroid and aldosterone supplements. Surgery and interventional radiology were consulted, but patient had no drainage or surgical procedures. His bleeding improved by itself. Adrenal hemorrhage is a rare but potentially lethal medical condition, if left untreated can result in adrenal insufficiency, acute adrenal crisis, and mortality due to distributive and hemorrhagic shock. Classically, it is linked to trauma, severe sepsis mainly associated to meningococcus, adrenal tumors, antiphospholipid syndrome, heparin associated thrombocytopenia and anticoagulant use. In our case, no particular etiology was identified and he was diagnosed to have spontaneous bilateral adrenal hemorrhage.