Aneke Ikenna Anderson, Gunendran Thiruendran
Department of Urology, Wythenshawe Hospital, Manchester, UK.
J Surg Case Rep. 2021 Oct 12;2021(10):rjab440. doi: 10.1093/jscr/rjab440. eCollection 2021 Oct.
Bilateral adrenal hemorrhage (BAH) is a rare condition, which can easily become a serious threat to life. It is even rarer in the setting of antiphospholipid syndrome (APLS), which in itself is associated with coagulopathy as well as the need for lifelong anticoagulation. Death from BAH is commonly due to adrenal insufficiency from infarction within the gland. Our case is that of a 53-year-old woman with APLS who presented to the emergency department with a markedly raised international normalized ratio and bilateral loin pain. She developed adrenal insufficiency and required glucocorticoids while on admission. Her anticoagulants were also adjusted and she received vitamin K. She made good progress thereafter and was discharged after 11 days. Vitamin K should be considered in patients with markedly deranged clotting profile and BAH to prevent ongoing bleeding. Early adrenal axis testing is also recommended to forestall delayed diagnosis of adrenal insufficiency.
双侧肾上腺出血（BAH）是一种罕见病症，很容易对生命构成严重威胁。在抗磷脂综合征（APLS）背景下更为罕见，而抗磷脂综合征本身与凝血病以及终身抗凝需求相关。BAH导致的死亡通常是由于肾上腺内梗死引起的肾上腺功能不全。我们的病例是一名53岁患有APLS的女性，因国际标准化比值显著升高和双侧腰痛就诊于急诊科。她出现了肾上腺功能不全，住院期间需要使用糖皮质激素。她的抗凝剂也进行了调整，并接受了维生素K治疗。此后她恢复良好，11天后出院。对于凝血指标明显异常且患有BAH的患者，应考虑使用维生素K以防止持续出血。还建议尽早进行肾上腺轴检测，以避免肾上腺功能不全的延迟诊断。
