Post-operative bilateral adrenal haemorrhage: A case report

Area of Science:

• Endocrinology
• Surgical Complications
• Critical Care Medicine

Background:

• Bilateral adrenal hemorrhage is a rare but serious condition with a 15% mortality rate.
• The exact mechanism of adrenal hemorrhage is unclear, often occurring in patients with acute, stressful illnesses.
• Diagnosis is challenging due to non-specific symptoms and variable electrolyte abnormalities.

Purpose of the Study:

• To report a case of adrenal crisis secondary to bilateral adrenal hemorrhage in a surgical patient.
• To highlight the diagnostic difficulties associated with vague symptoms and electrolyte variations in post-operative surgical patients.
• To emphasize the importance of timely recognition, treatment, and long-term management of adrenal failure.

Main Methods:

• Case report of a surgical patient following emergency surgery for intra-abdominal sepsis.
• Monitoring of post-operative symptoms including confusion, mild pyrexia, and abdominal pain.
• Assessment of electrolyte abnormalities and serum cortisol levels.
• Treatment with intravenous hydrocortisone, intensive monitoring, and long-term fludrocortisone.

Main Results:

• The patient presented with non-specific symptoms and subtle electrolyte abnormalities, including acute hyponatremia and normal potassium.
• Low serum cortisol indicated adrenal crisis.
• Timely medical treatment and follow-up resulted in a satisfactory outcome.

Conclusions:

• Adrenal crisis secondary to bilateral adrenal hemorrhage is a potentially life-threatening complication in surgical patients.
• Vague symptoms and atypical electrolyte profiles (e.g., hyponatremia with normal potassium) can mask this condition.
• Awareness, early recognition, prompt treatment, and long-term management are vital for preventing relapse and ensuring patient recovery.