Bleasel J F, Rasko J E, Rickard K A, Richards G
Rheumatology Department, Rachel Forster Hospital, Redfern, NSW.
Med J Aust. 1992 Aug 3;157(3):192-3. doi: 10.5694/j.1326-5377.1992.tb137086.x.
To present a case of acute adrenal insufficiency secondary to heparin-induced thrombocytopenia-thrombosis syndrome (HITTS), an important though rare complication of heparin therapy.
A 69-year-old woman developed HITTS secondary to low dose heparin administered subcutaneously as prophylaxis against deep venous thrombosis. This followed a revision of a knee replacement. The first manifestation of HITTS was the development of pulmonary emboli in the setting of a falling platelet count. Bilateral adrenal haemorrhages complicated her course resulting in acute adrenal insufficiency. Non-specific symptoms dominated the clinical picture, with fever, nausea, abdominal pain and vomiting. Symptomatic postural hypotension was noted later in the course of her illness.
The diagnosis of adrenal insufficiency was confirmed by short Synacthen test plus computed tomographic scanning which demonstrated bilateral adrenal haemorrhages. Steroid replacement resulted in rapid clinical improvement.
This case demonstrates one of the life threatening complications that may occur with heparin even in prophylactic doses. Regular platelet counts are essential to detect heparin-induced thrombocytopenia at an early stage.
报告一例继发于肝素诱导的血小板减少-血栓形成综合征（HITTS）的急性肾上腺功能不全病例，HITTS是肝素治疗一种虽罕见但重要的并发症。
一名69岁女性在接受皮下注射低剂量肝素预防深静脉血栓形成后发生HITTS。此次是在膝关节置换翻修术后。HITTS的首发表现是在血小板计数下降的情况下出现肺栓塞。双侧肾上腺出血使病情复杂化，导致急性肾上腺功能不全。非特异性症状主导临床表现，包括发热、恶心、腹痛和呕吐。在病程后期出现了有症状的体位性低血压。
通过短程促肾上腺皮质激素试验加计算机断层扫描确诊肾上腺功能不全，扫描显示双侧肾上腺出血。激素替代治疗使临床症状迅速改善。
本病例表明即使是预防性剂量的肝素也可能发生危及生命的并发症。定期检测血小板计数对于早期发现肝素诱导的血小板减少至关重要。
