Department of General Medicine, Monash Health, Clayton, VIC, Australia.
Department of Haematology, Monash Health, Clayton, VIC, Australia.
J Med Case Rep. 2024 Oct 25;18(1):518. doi: 10.1186/s13256-024-04834-3.
Bilateral adrenal hemorrhage is a rare but often a fatal cause of primary adrenal insufficiency that can result in adrenal crisis if not identified and managed appropriately.
We present a case of a 27-year-old Caucasian female who was admitted to the hospital 17 days postpartum with pleuritic chest and flank pain, shortness of breath and nausea. Computed tomography imaging confirmed multiple thromboemboli including pulmonary emboli and noted bilateral bulky adrenal glands. She was managed for infection and pulmonary emboli; however, she complained of persistent headaches, nausea, and vomiting despite appropriate management. Radiology re-review found the computed tomography imaging was consistent with bilateral adrenal hemorrhage in hindsight. Subsequent endocrine evaluation with hypothalamic-pituitary-adrenal axis interrogation and adrenocorticotropic hormone (Synacthen) stimulation testing confirmed resultant primary adrenal insufficiency. She required urgent intravenous hydrocortisone and was subsequently discharged on oral adrenal replacement therapy and anticoagulation.
Delay in identification and treatment of adrenal insufficiency can lead to catastrophic outcomes. This case highlights the challenge of diagnosing bilateral adrenal hemorrhage and resultant adrenal insufficiency as patients may not present with the classic risk factors, signs, symptoms, and electrolyte derangements.
双侧肾上腺出血是导致原发性肾上腺功能不全的罕见但常致命的原因，如果不能及时识别和适当处理，可能导致肾上腺危象。
我们报告了一例 27 岁的白人女性，产后 17 天因胸痛、肋痛、呼吸急促和恶心而住院。计算机断层扫描成像证实存在多发性血栓栓塞，包括肺栓塞，并注意到双侧肾上腺肿大。她接受了感染和肺栓塞的治疗；然而，尽管治疗得当，她仍持续抱怨头痛、恶心和呕吐。放射科重新评估发现，计算机断层扫描成像与双侧肾上腺出血一致。随后对下丘脑-垂体-肾上腺轴进行内分泌评估以及促肾上腺皮质激素（Synacthen）刺激试验，证实了原发性肾上腺功能不全的结果。她需要紧急静脉注射氢化可的松，随后出院接受口服肾上腺替代治疗和抗凝治疗。
延迟识别和治疗肾上腺功能不全可能导致灾难性后果。本病例强调了诊断双侧肾上腺出血和继发的肾上腺功能不全的挑战，因为患者可能没有出现典型的危险因素、体征、症状和电解质紊乱。
