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March 26, 1982

Bilateral Adrenal Hemorrhage in an Adult: Demonstration by Computed Tomography

JAMA. 1982;247(12):1737-1739. doi:10.1001/jama.1982.03320370051031

ACUTE bilateral adrenal hemorrhage has been reported in postoperative patients,1 in patients with hemorrhagic diatheses,2,3 and in association with severe stress and hypotension.4 The diagnosis is considered infrequently before death because symptoms may be masked or ascribed to more common clinical conditions.

Twelve days after an uncomplicated surgical procedure, a patient with a mild hemorrhagic diathesis experienced acute bilateral adrenal hemorrhage. The symptoms and signs were initially ascribed to more common postoperative complications. The routine laboratory evaluation results did not suggest adrenal insufficiency. The diagnosis of acute adrenal hemorrhage and adrenal insufficiency was suggested by computed tomography (CT) and confirmed by a cosyntropin stimulation test.

Report of a Case  A 46-year-old man was admitted for removal of an accessory spleen because of thrombocytopenia. A diagnosis of poorly differentiated lymphocytic lymphoma, stage 3B, had been made four years earlier. Splenectomy had been performed at the initial staging laparotomy.