Nazir Salik, Sivarajah Surendra, Fiscus Valena, York Eugene
Department of Internal Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.
Department of Endocrinology and Metabolism, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.
BMJ Case Rep. 2016 May 10;2016:bcr2016215452. doi: 10.1136/bcr-2016-215452.
We describe a case of a 62-year-old woman with a history of chronic obstructive pulmonary disease and gastro-oesophageal reflux disease who presented to the emergency department with left lower quadrant abdominal pain, flank pain with nausea and no history of preceding trauma. The patient had finished a course of azithromycin and oral methylprednisolone 1 day prior to presentation. Abdominal and pelvic CT scan identified changes suggestive of bilateral adrenal haemorrhage. The patient did not show signs of acute adrenal insufficiency but was started on steroid replacement therapy because of concerns about possible disease progression. All recognised causes of adrenal haemorrhage were excluded suggesting this was a case of spontaneous idiopathic bilateral adrenal haemorrhage, a rarely reported phenomenon in the literature. The patient was discharged after clinical improvement following 6 days in hospital, taking oral steroid replacement.
我们描述了一例62岁女性患者，有慢性阻塞性肺疾病和胃食管反流病病史，因左下腹疼痛、胁腹疼痛伴恶心就诊于急诊科，无前驱创伤史。患者在就诊前1天完成了阿奇霉素和口服甲泼尼龙疗程。腹部和盆腔CT扫描发现提示双侧肾上腺出血的改变。患者未表现出急性肾上腺功能不全的体征，但因担心可能的疾病进展而开始接受类固醇替代治疗。排除了所有已知的肾上腺出血原因，提示这是一例自发性特发性双侧肾上腺出血，这在文献中是一种罕见报道的现象。患者住院6天后临床症状改善，口服类固醇替代药物后出院。
