Bilateral adrenal hemorrhage in polycythemia vera

Area of Science:

• Endocrinology
• Critical Care Medicine

Background:

• Bilateral adrenal hemorrhage (BAH) is a rare complication in critically ill patients.
• It can lead to life-threatening acute adrenal insufficiency if not recognized and treated promptly.

Observation:

• A 64-year-old male with polycythemia vera presented with unresponsiveness, fever, hypotension, tachycardia, and hypoglycemia.
• Initial investigations revealed ST-elevation on ECG, elevated troponin, hemoglobin, PT, and PTT, requiring aggressive cardiorespiratory support.

Findings:

• The patient remained hypotensive despite coronary intervention. A low random cortisol level prompted suspicion of BAH.
• Stress-dose hydrocortisone administration resulted in immediate hemodynamic stabilization.
• Non-contrast abdominal CT confirmed bilateral adrenal hemorrhage.

Implications:

• This case highlights the importance of considering BAH in critically ill patients with unexplained shock and adrenal insufficiency.
• Timely diagnosis and initiation of corticosteroid therapy are crucial for improving outcomes and reducing mortality in acute adrenal insufficiency secondary to BAH.