Bilateral adrenal hemorrhage associated with prior steroid use: CT diagnosis

We report an adult man who developed clinical signs suggestive of septic shock postoperatively. An abdominal computed tomographic (CT) scan was obtained to look for a possible source of infection prior to repeat surgery. The CT scan revealed bilateral homogeneously enlarged hyperdense adrenal glands interpreted as representing adrenal hemorrhage. A diagnosis of acute adrenal insufficiency was suggested by the radiologist and appropriate therapy instituted. The adrenal hemorrhage was felt to be secondary to surgical stress in a patient with marginal adrenal function because of prior glucocorticoid use. The clinical features, etiologies and CT findings of adrenal hemorrhage and insufficiency in an adult are described.