Delhumeau A, Moreau X, Chapotte C, Houi N, Bigorgne J C
Department of Anesthesiology, Centre Hospitalier Universitaire d'Angers, France.
Intensive Care Med. 1993;19(8):475-7. doi: 10.1007/BF01711091.
A 74-year-old man developed bilateral arterial thrombosis of the lower limbs related to heparin-associated thrombocytopenia syndrome (HATS). On day 4 after thrombectomy of both limbs, abdominal pain, fever, hypotension, abdominal tenderness appeared. Acute acalculous cholecystitis was suspected and cholecystectomy was carried out although the gallbladder was not imflamed. Later on, hyponatremia in addition to the aforesaid signs suggested the diagnosis of adrenal insufficiency. Diagnosis was confirmed by low cortisol and aldosterone plasma concentration and by CT scan, which showen two enlarged adrenal glands. HATS might explain two unexpected facts: occurrence of adrenal hemorrhage during heparin therapy with coagulation tests within the therapeutic range and paradoxical thrombosis in the central vein of adrenal gland. HATS must be regarded as one cause of adrenal hemorrhage necrosis.
一名74岁男性发生了与肝素相关性血小板减少综合征（HATS）相关的双下肢动脉血栓形成。在双下肢血栓切除术后第4天，出现腹痛、发热、低血压和腹部压痛。尽管胆囊未发炎，但怀疑为急性非结石性胆囊炎并进行了胆囊切除术。后来，除上述症状外出现低钠血症提示肾上腺功能不全的诊断。低皮质醇和醛固酮血浆浓度以及CT扫描显示双侧肾上腺增大，从而确诊。HATS可能解释了两个意外情况：在肝素治疗期间凝血试验在治疗范围内时发生肾上腺出血，以及肾上腺中央静脉出现反常血栓形成。HATS必须被视为肾上腺出血坏死的原因之一。
