Postoperative primary adrenal failure from bilateral hemorrhagic adrenal infarction associated with coagulation factor XI deficiency.

A 72-year-old man developed bilateral adrenal hemorrhage causing primary adrenal failure three days after total hip replacement, and was found to have coagulation factor XI deficiency. Factor XI deficiency usually causes mild bleeding which is not predictable on the basis of assayable factor XI levels. There have been no previous reports of bilateral adrenal hemorrhage in factor XI deficiency or other inherited coagulation factor deficiencies. We suggest that the risk of bilateral adrenal hemorrhage should be considered in any preoperative evaluation of patients with factor XI deficiency.