Postoperative bilateral adrenal hemorrhage: correlation between clinical and radiological signs

Corsini, L. Muñoz; Arnaiz, C. Delgado; García-del-Valle, Santiago; Cortes, Pilar Reboto; Castillo, A. Lopez del

doi:10.1016/j.jclinane.2008.05.024

Cited by 8 publications

(15 citation statements)

References 18 publications

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“…Other symptoms like neuropsychiatric presentations, hypotension and anaemia are uncommon (27). A number of conditions are reported to be associated with non-traumatic adrenal haemorrhage as mentioned previously (3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Recognition of these existing predisposing factors (in particular anticoagulant use) may help determine the initial management plan in this group of patients.…”

Section: Discussionmentioning

confidence: 92%

“…Literature on the management of adrenal haemorrhage is limited. In the published case reports, most patients are initially treated conservatively (5,(10)(11)(12)(13)(14). Surgical resection has been performed electively by either the open or laparoscopic approach (9,21).…”

Section: Original Articlementioning

confidence: 99%

“…Non-traumatic adrenal haemorrhage has been reported in association with underlying stress like sepsis, pregnancy, and after abdominal surgery (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). During this period, there is a surge of circulating catecholamines and adrenocorticotrophic hormone (ACTH) that leads to vasoconstriction of the draining venules (15).…”

Section: Introductionmentioning

confidence: 99%

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Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

Ali¹,

Singh²,

Balasubramanian³

2018

Gland Surg

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Background: Acute adrenal haemorrhage is a rare medical emergency. The aim of the series was to study the clinical presentation and management of patients presenting with acute non-traumatic adrenal haemorrhage. Methods: The records of patients presenting with an acute abdomen secondary to adrenal haemorrhage and treated in a tertiary endocrine surgical unit over a period of 6 years were reviewed. Results: Of the 11 included patients, there were 4 males and 7 females; the median [range] age at presentation was 58 [27-89] years. All were initially managed conservatively for bleeding, except one who underwent angioembolisation to ensure hemodynamic stability. Two patients underwent percutaneous drainage of persistent collection and suspected sepsis. Biochemical workup showed hyper function with metanephrine excess in 1 patient. Adrenalectomy was performed in 5 patients after a median [range] of 10 [7-11] weeks. Histology showed benign pathology in 2 patients, malignant in 2 patients and necrotic tumour in 1 patient. Two patients died of disseminated metastatic disease at 5 and 2 months after presentation with bleeding. Conservative management in the other 3 patients was successful at a median follow up of 26 [6-66] months. Conclusions: Acute adrenal haemorrhage is usually associated with an underlying pathology; which may be benign or malignant; functional or non-functional. Initial conservative management is preferred as it allows determination of functional status and elective surgery, if necessary.

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Section: Discussionmentioning

confidence: 92%

Section: Original Articlementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

Ali¹,

Singh²,

Balasubramanian³

2018

Gland Surg

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“…Other findings, such as laboratory tests indicating electrolyte changes of adrenal insufficiency or sudden drops in hemoglobin and hematocrit levels are seen in only about half of the patients . When clinically suspected, the computed tomography (CT) scan is considered paramount in the diagnosis of adrenal hemorrhage, and the evolution of the disease can be tracked radiologically . Also, adrenal hemorrhage may be found incidentally during the radiologic survey of other abdominal or retroperitoneal processes, or during evaluation for abdominal pain .…”

Section: Discussionmentioning

confidence: 99%

The Significance of Adrenal Hemorrhage: Undiagnosed Waterhouse‐Friderichsen Syndrome, A Case Series

Tormos

Schandl

2013

Journal of Forensic Sciences

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A retrospective series of five cases of nontraumatic gross adrenal hemorrhage were identified in 800 consecutive forensic autopsies. All patients were males, of different ethnicities and with ages ranging from 2 to 48 years. All patients had a clinical history and autopsy findings suggestive of sepsis. Pre- or postmortem microbiological cultures were variably positive for Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus. The fifth case was positive for yeast and a coagulase negative staphylococcus; contamination of this culture medium cannot be excluded. No cases had a culture positive for Neisseria meningitidis. We find that the reviewed patients with grossly or microscopically identifiable adrenal hemorrhage were otherwise healthy individuals who died suddenly as a consequence of bacterial infection. In each case, signs and symptoms compatible with premortem adrenal insufficiency were reported; in no instance was the adrenal hemorrhage clinically identified.

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“…If clinically suspected, the CT scan of the abdomen is strongly suggested as “gold standard” in the diagnosis of adrenal hemorrhage. [23] The therapy should be started as soon as the diagnosis is suspected, due to the lethal and fulminant course of this syndrome. It consists of antibiotic administration and, in particular, Penicillin G is the most suggested in N meningitidis infection, while third-generation cephalosporin can be used when the organism is unknown.…”

Section: Discussionmentioning

confidence: 99%

A unique fatal case of Waterhouse–Friderichsen syndrome caused by Proteus mirabilis in an immunocompetent subject

Spagnolo¹,

Mondello

Roccuzzo

et al. 2019

Medicine

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Introduction: The Waterhouse–Friderichsen syndrome (WFS), also known as purpura fulminans, is a potentially lethal condition described as acute hemorrhagic necrosis of the adrenal glands. It is often caused by infection. Classically, Neisseriae meningitidis represents the main microorganism related to WFS, although, infrequently, also other infectious agents are reported as a possible etiologic agent. The authors report the first case of death due to Proteus mirabilis infection, with postmortem evidence of WFS. Patient concerns: After a facial trauma that provoked a wound on the nose, the subject, a healthy 40-years old man, was conducted to the local hospital (in Sicily, Italy) after the primary care he was discharged. Subsequently, after 2 days of general malaise, he returned to the hospital due to the worsening of the clinical condition. During the hospitalization, hypotension, and neurological impairment appeared; the laboratory analysis showed leukocytosis and the alteration of renal, hepatic and coagulative parameters. Microbiological blood analysis resulted positive for a P mirabilis infection. Diagnosis: Multiorgan failure (MOF) with disseminated intravascular coagulation (DIC) due to sepsis was diagnosed. Interventions: The practitioners administered intensive support, antibiotic therapy, antithrombin III, vitamin K, and plasma. Outcomes: After 3 days the subject died. The autopsy and the microscopic investigation were performed revealing, also, the adrenal diffuse micronodular hyperplasia associated with a cortico-medullary hemorrhagic apoplexy. Conclusion: To our knowledge, this is the first case of MOF with WFS due to P mirabilis infection. This case report suggests that P mirabilis should be added to the list of unusual bacteria causing WFS. Furthermore, it supports the theory that any bacterium which causes DIC may cause adrenal hemorrhage and should suggest to clinicians the importance to consider a potential adrenal involvement in every patient with sepsis and DIC.

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Postoperative bilateral adrenal hemorrhage: correlation between clinical and radiological signs

Cited by 8 publications

References 18 publications

Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

The Significance of Adrenal Hemorrhage: Undiagnosed Waterhouse‐Friderichsen Syndrome, A Case Series

A unique fatal case of Waterhouse–Friderichsen syndrome caused by Proteus mirabilis in an immunocompetent subject

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