Spontaneous Idiopathic Bilateral Adrenal Apoplexy Associated With Hypertension

Abstract

Although bilateral adrenal hemorrhage has been commonly found at the postmortem examination of a person who died suddenly, it has been associated with meningococcemia or other sepsis,1 pregnancy,2 the neonatal state,3 heparin therapy,4 or leukemia.5 Standard textbooks refer only to these primary causes.6 Unilateral adrenal apoplexy complicating hypertension is also rare but several cases were reported in 1945 by Edelman.7

Adrenal Hemorrhage and Necrosis in the Adult

“…Adrenal bleeding and necrosis have been described in connection not only with septicemia and severe acute infections but also with numerous other conditions. These include pregnancy and delivery, hypertension, burns, trauma, during convulsions in epilepsy or during electro-convulsive therapy, pemphigus, surgical operations and chronic or asthmatic bronchitis (1,2,7,8,12,13,14,15,18,20,21,25,30).…”

“…Recently the connection between the administration of ACTH and adrenal damage has been the subject of great interest. Several cases have been described of adrenal injuries following ACTH treatment (11,15,27,36). Deaths have been reported following ACTH tests on patients with adrenal cortical hypoplasia (33).…”

“…Acute infection without any signs of septicemia occurred in several cases. Four cases (3,4,14,15) had bronchopneumonia to such an extent that it can be assumed to have affected the course of the disease. One case (10) had both bronchopneumonia and acute cystopyelonephri tis.…”

“…with an operation. Two cases (12,15) were subjected to gastric resection and two (9,17) to operations on the bile ducts. In one case (13) a splenectomy was performed and in another (16) the shoulder joint was mobilized under general anesthesia.…”