A Case of Bilateral Adrenal Hemorrhage: The Exceptional Cause of Adrenal Insufficiency

Khakwani, Aemen S; Waqar, Fatima; Anwar, Muhammad Nadeem

doi:10.7759/cureus.23413

Cited by 4 publications

(6 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…BAH can occur late, up to 3 weeks after a sepsis, shock or postoperative period (1). In our case, the adrenal hemorrhage was not visible until the second CT scan, 4 days after the onset of symptoms.…”

Section: Discussionmentioning

confidence: 47%

See 1 more Smart Citation

An unusual cause of abdominal pain: spontaneous bilateral adrenal hemorrhage

Rodriguez Tebar,

Panza-Nduli,

Gubin

et al. 2023

AGEB

View full text Add to dashboard Cite

Bilateral adrenal hemorrhage (BAH) is a rare condition that can lead to acute adrenal insufficiency and death if not recognized and treated promptly. We report the case of a 30-year-old male who presented to the emergency department with acute abdominal pain, nausea, and vomiting. On emergency room admission, the first abdominal CT revealed normal adrenal glands without enlargement, but with the development of hypotension and hypoglycemia, a second CT performed four days later showed enlargement due to hemorrhage in both adrenals. The diagnosis of BAH associated with acute adrenal insufficiency was retained. Prompt treatment with intravenous and oral corticosteroids resulted in successful conservative management. We describe the clinical, biological, radiological and etiological features of this condition based on a review of the literature.

show abstract

Section: Discussionmentioning

confidence: 47%

“…Bilateral adrenal hemorrhage (BAH) is an uncommon cause of acute adrenal insufficiency, with a mortality rate of 15% (1). BAH is often described as a rare event.…”

Section: Introductionmentioning

confidence: 99%

An unusual cause of abdominal pain: spontaneous bilateral adrenal hemorrhage

Rodriguez Tebar,

Panza-Nduli,

Gubin

et al. 2023

AGEB

View full text Add to dashboard Cite

show abstract

“… 121 An unusual cause was described on a 64-year-old male after a fall complicated with a hip fracture. 122 A new case of Waterhouse-Friderichsen syndrome due to methicillin-resistant Staphylococcus aureus bacteremia was reported, too 123 ( Table 6 ).…”

Section: Discussionmentioning

confidence: 99%

“… 122 A new case of Waterhouse-Friderichsen syndrome due to methicillin-resistant Staphylococcus aureus bacteremia was reported, too 123 ( Table 6 ).…”

Section: Discussionmentioning

confidence: 99%

Addison’s Disease: Diagnosis and Management Strategies

Cârșote¹,

Nistor²

2023

IJGM

View full text Add to dashboard Cite

We aim to overview Addison’s disease (AD) with regard to current diagnosis and management. This is a narrative review of full-length articles published in English between January 2022 and December 2022 (including online ahead of print versions) in PubMed-indexed journals. We included original studies in living humans regardless of the level of statistical significance starting from the key search terms “Addison’s disease” or “primary adrenal insufficiency” in title or abstract. We excluded articles with secondary adrenal insufficiency. Briefly, 199 and 355 papers, respectively were identified; we manually checked each of them, excluded the duplicates, and then selected 129 based on their clinical relevance in order to address our 1-year analysis. We organized the data in different subsections covering all published aspects on the subject of AD. To our knowledge, this is the largest AD retrospective from 2022 on published data. A massive role of genetic diagnosis especially in pediatric cases is highlighted; the importance of both pediatric and adult awareness remains since unusual presentations continue to be described. COVID-19 infection is a strong player amid this third year of pandemic although we still not do have large cohorts in this particular matter as seen, for instance, in thyroid anomalies. In our opinion, the most important topic for research is immune checkpoint inhibitors, which cause a large panel of endocrine side effects, AD being one of them.

show abstract

“…However, complications arise when the damage is permanent, treated late, or when the adjuvant (e.g., vaccines) or latent viral infection (e.g., herpesvirus) chronically persists in the body, directly (persistence of ACTH-mimetic viral antigen) or indirectly affecting the HPA axis (via proinflammatory cytokines) ( 10 , 67 , 76 , 246 , 249 ). In such cases, chronic replacement therapy with corticosteroids could be considered, albeit with the risk of pituitary and adrenal atrophy ( 246 , 250 ). Conversely, if there is no evidence of pituitary damage and ACTH levels are normal, but there is a hyporesponsiveness of the HPA axis, it would be prudent to consider other treatment options before resorting to prolonged corticosteroid use.…”

Section: Treatmentmentioning

confidence: 99%

Hypocortisolemic ASIA: a vaccine- and chronic infection-induced syndrome behind the origin of long COVID and myalgic encephalomyelitis

Ruiz-Pablos,

Paiva,

Zabaleta

2024

Front. Immunol.

View full text Add to dashboard Cite

Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), long COVID (LC) and post-COVID-19 vaccine syndrome show similarities in their pathophysiology and clinical manifestations. These disorders are related to viral or adjuvant persistence, immunological alterations, autoimmune diseases and hormonal imbalances. A developmental model is postulated that involves the interaction between immune hyperactivation, autoimmune hypophysitis or pituitary hypophysitis, and immune depletion. This process might begin with a deficient CD4 T-cell response to viral infections in genetically predisposed individuals (HLA-DRB1), followed by an uncontrolled immune response with CD8 T-cell hyperactivation and elevated antibody production, some of which may be directed against autoantigens, which can trigger autoimmune hypophysitis or direct damage to the pituitary, resulting in decreased production of pituitary hormones, such as ACTH. As the disease progresses, prolonged exposure to viral antigens can lead to exhaustion of the immune system, exacerbating symptoms and pathology. It is suggested that these disorders could be included in the autoimmune/adjuvant-induced inflammatory syndrome (ASIA) because of their similar clinical manifestations and possible relationship to genetic factors, such as polymorphisms in the HLA-DRB1 gene. In addition, it is proposed that treatment with antivirals, corticosteroids/ginseng, antioxidants, and metabolic precursors could improve symptoms by modulating the immune response, pituitary function, inflammation and oxidative stress. Therefore, the purpose of this review is to suggest a possible autoimmune origin against the adenohypophysis and a possible improvement of symptoms after treatment with corticosteroid replacement therapy.

show abstract

A Case of Bilateral Adrenal Hemorrhage: The Exceptional Cause of Adrenal Insufficiency

Cited by 4 publications

References 8 publications

An unusual cause of abdominal pain: spontaneous bilateral adrenal hemorrhage

An unusual cause of abdominal pain: spontaneous bilateral adrenal hemorrhage

Addison’s Disease: Diagnosis and Management Strategies

Hypocortisolemic ASIA: a vaccine- and chronic infection-induced syndrome behind the origin of long COVID and myalgic encephalomyelitis

Contact Info

Product

Resources

About