1/9. Acute adrenocortical insufficiency due to heparin-induced thrombocytopenia with subsequent bilateral haemorrhagic infarction of the adrenal glands.A 56 year old male developed bilateral massive adrenal haemorrhage (BMAH) resulting in chronic adrenal insufficiency in the course of heparin-induced thrombocytopenia (HIT)-syndrome. Thrombosis of the central adrenal vein (CAV) with subsequent adrenal haemorrhagic infarction is the most probable cause of the rare association of HIT and BMAH. The exorbitantly high catecholamine plasma levels within the CAV in addition to immunogenic platelet activation are discussed as possible underlying pathophysiological mechanisms.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/9. Acute adrenal failure as the heralding symptom of primary antiphospholipid syndrome: report of a case and review of the literature.Acute adrenal failure is a potentially fatal condition if overlooked. Occasionally, acute adrenal insufficiency may ensue from bilateral adrenal haemorrhage in patients with known antiphospholipid syndrome (APS). APS is characterized by recurrent arterial and venous thrombosis, pregnancy complications and detection of autoantibodies to phospholipids. This syndrome may be associated with non-organ specific diseases (e.g. connective tissue disorders) or with malignancies, but it may also appear in isolated form (primary APS). In a very few cases the heralding manifestation is given by adrenal failure. We report here a 63-year-old man presenting with acute adrenal insufficiency as the opening clinical manifestation of an APS. We also carried out a computer-aided search of the literature to identify all cases of primary adrenal failure as the first-recognized expression of a primary APS, a condition that not so infrequently may be tackled by endocrinologists. 20 patients fulfilled the inclusion criteria. The great majority of them were males (75%) with a mean age of 42 years. abdominal pain was present in 14 patients, followed by fever (13 patients) and hypotension (12 patients). The main morphological findings by computed tomography or magnetic resonance were consistent with bilateral adrenal haemorrhage in 11 patients. Lupus anticoagulant was present in all of the 19 tested patients. Our observations emphasize the importance in the assessment of clotting times, and possibly of antiphospholipid antibodies, in all patients with diagnosis of rapidly progressive adrenal failure and concurrent abdominal pain.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
3/9. Acute adrenal insufficiency secondary to heparin-induced thrombocytopenia-thrombosis syndrome.OBJECTIVE: To present a case of acute adrenal insufficiency secondary to heparin-induced thrombocytopenia-thrombosis syndrome (HITTS), an important though rare complication of heparin therapy. CLINICAL FEATURES: A 69-year-old woman developed HITTS secondary to low dose heparin administered subcutaneously as prophylaxis against deep venous thrombosis. This followed a revision of a knee replacement. The first manifestation of HITTS was the development of pulmonary emboli in the setting of a falling platelet count. Bilateral adrenal haemorrhages complicated her course resulting in acute adrenal insufficiency. Non-specific symptoms dominated the clinical picture, with fever, nausea, abdominal pain and vomiting. Symptomatic postural hypotension was noted later in the course of her illness. INTERVENTION AND OUTCOME: The diagnosis of adrenal insufficiency was confirmed by short Synacthen test plus computed tomographic scanning which demonstrated bilateral adrenal haemorrhages. Steroid replacement resulted in rapid clinical improvement. CONCLUSIONS: This case demonstrates one of the life threatening complications that may occur with heparin even in prophylactic doses. Regular platelet counts are essential to detect heparin-induced thrombocytopenia at an early stage.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
4/9. Hypercalcaemia in acute adrenal insufficiency. A case report.A woman aged 62 developed a septic shock and pulmonary embolism after skin grafting for extensive burns. She was put on anticoagulants. A second shock led to renal insufficiency. Hypercalcaemia developed. A CT scan of the upper abdomen disclosed enlarged adrenal glands. An acute adrenal haemorrhage was suspected. The levels of cortisol were low in the plasma and urine and did not respond to ACTH stimulation. Cortisone replacement therapy improved the condition of the patient and normalized plasma calcium levels. The mechanisms of hypercalcaemia in acute adrenal insufficiency are discussed. Multiple factors have been proposed: haemoconcentration, an increased affinity of plasma proteins for calcium, an increase in the filtrable calcium complexes, and an enhanced calcium mobilization of skeletal origin.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
5/9. adrenal insufficiency and bilateral adrenal enlargement: demonstration by computed tomography.A patient presented with fever, malaise and a staphylococcal wound infection occurring 3 weeks after severe haemorrhage from a lacerated brachial artery. There were no clinical features to suggest Addison's disease but abdominal computed tomography to exclude abdominal sepsis showed bilateral adrenal gland enlargement with preservation of adrenal shape. This was consistent with resolving adrenal haemorrhage or infarction and endocrinological investigations confirmed primary adrenal failure.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
6/9. Primary antiphospholipid syndrome associated with postoperative primary adrenal failure.A 51-year-old Caucasian male without previous history of thromboembolic disease developed Coomb's positive haemolytic anaemia, thrombocytopenia, transient paranoid psychosis and bilateral adrenal haemorrhage with primary adrenal failure after surgery for inguinal hernia. The activated partial thromboplastin time was spontaneously prolonged, and lupus anticoagulant and anticardiolipin antibodies were detected. In the absence of criteria for classification of systemic lupus erythematosus (SLE), the entity was classified as a primary antiphospholipid syndrome. Despite the persistence of the serological abnormalities, the patient remains well after substitution with cortisone. Primary adrenal failure due to adrenal haemorrhage can be associated with the primary antiphospholipid syndrome.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
7/9. adrenal insufficiency secondary to postoperative bilateral adrenal haemorrhage.Two case reports are presented of adrenal insufficiency due to bilateral adrenal haemorrhage following surgery. This unusual complication with its non-specific manifestations may result in unexpected clinical deterioration of the postoperative patient. Corticosteroid replacement and repletion of sodium and water deficits should be given promptly when adrenal haemorrhage is suspected.- - - - - - - - - - ranking = 6keywords = haemorrhage (Clic here for more details about this article) |
8/9. Acute adrenal insufficiency in the burn intensive care unit.Acute adrenal insufficiency may underlie a confusing, stormy, intensive care unit course after a burn. The aetiology is most likely to be adrenal haemorrhage despite the absence of a coagulopathy. This report describes two patients who were diagnosed antemortem and successfully treated with replacement therapy. The aetiology, presentation, diagnosis and treatment of acute adrenal insufficiency in the intensive care unit is reviewed.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
9/9. antiphospholipid syndrome, adrenal failure, dilated cardiomyopathy and chronic hepatitis: an unusual manifestation of multiorgan autoimmune injury?The antiphospholipid syndrome is characterized by clinical evidence of arterial or venous thrombosis, thrombocytopaenia, recurrent fetal loss and repeated positivity of antiphospholipid autoantibodies. The association of antiphospholipid syndrome with the development of adrenal failure has been reported in more than 40 patients in the last 20 years, mostly due to bilateral cortical haemorrhage or thrombosis of adrenal vessels. The presence of antibodies against adrenal cortex was never documented in these patients. Here we report a case of recurrent thrombophlebitis, acute adrenal failure, and chronic hepatitis occurring in a young man found to have antiphospholipid antibodies and lupus anticoagulant. autoantibodies against adrenal cortex were detected and abdominal ultrasonography showed morphologically normal adrenals. Mild thrombocytopaenia, Coomb's positive anaemia, increase in alanine- and aspartate-aminotransferases and increase in urinary protein excretion were found. autoantibodies against liver/kidney microsomes were positive and liver biopsy was compatible with autoimmune hepatitis. The patient was treated with cortisone acetate, fludrocortisone and warfarin. Dilated cardiomyopathy was revealed one year later and coronarography did not document any occlusive coronary disease. Three years later, titres of autoantibodies, including those directed towards the adrenal cortex, were increased and others, previously absent, were detected. Nevertheless, the patient's clinical conditions seemed unchanged. At this time, an abdominal CT scan showed adrenal dysmorphisms with bilateral annular calcifications and central hypodensities suggesting previous bilateral adrenal haematomas. The hypercoagulable state that occurs in antiphospholipid syndrome can induce a localized inflammatory response generated by tissue injury, with a consequent release of intracellular antigens and antibodies production. Consequently, tissue-specific autoantibodies positivity may persist until the cells involved in antigen production are completely destroyed.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |