What is the role of bilateral adrenal hemorrhage in the development of acute Addison disease?

Updated: Mar 11, 2020
  • Author: George T Griffing, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Bilateral adrenal hemorrhage

  • This may be the cause of an acute adrenal crisis, and it may occur as a complication of bacterial infection with Meningococcus or Pseudomonas species, as in Waterhouse-Friderichsen syndrome.

  • It also may occur as a complication of pregnancy, anticoagulant therapy with heparin or warfarin, and as a complication of coagulopathies such as antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE).

  • The mechanism of action of adrenal hemorrhage is not fully understood. Diagnosis usually is made in the setting of a critically ill patient on anticoagulants (or with any of the causes mentioned above) who becomes acutely hypotensive with tachycardia, nausea, vomiting, fever, and confusion or disorientation. Abdominal or flank pain with associated tenderness may develop.

  • A rapid ACTH test usually should be performed in this setting, and the patient should be started on hydrocortisone without waiting for the results. When time is critical, a random cortisol should be drawn and the patient started on hydrocortisone in stress doses. An abdominal computed tomography (CT) scan often reveals bilateral adrenal gland enlargement.

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