Presumptive Postoperative Nontraumatic Adrenal Haemorrhage After Orthopaedic Surgery in a Dog

Nontraumatic adrenal haemorrhage (NTAH) is rarely reported in dogs and may be associated with clinically important adrenal dysfunction when both adrenal glands are affected. Surgery has been recognised as a potential precipitating stressor in humans, but postoperative NTAH has been rarely described in veterinary medicine.

A 7-year-old, 2.8-kg spayed female Chihuahua developed abrupt decompensation on postoperative day 1 after bilateral distal femoral osteotomy, characterised by hypothermia, hypotension, and recurrent hypoglycaemia. Clinicopathologic abnormalities included anaemia, thrombocytopenia, hypoalbuminaemia, increased C-reactive protein concentration, and increased D-dimer concentration. Abdominal ultrasonography identified bilateral adrenal enlargement with hypoechoic parenchyma and marked periadrenal hyperechogenicity, supporting a presumptive diagnosis of postoperative NTAH.

Prednisolone and supportive care resulted in rapid clinical stabilisation. Basal cortisol, initially within the reference interval, subsequently declined below the assay detection limit (<1.0 µg/dL), accompanied by a decrease in the sodium-to-potassium ratio. Serial ultrasonography documented progressive reductions in adrenal thickness, with the left adrenal thickness decreasing below commonly cited ultrasonographic cutoffs used to support hypoadrenocorticism. Cortisol and electrolyte indices normalised after discontinuation of glucocorticoids.

This case highlights presumptive postoperative NTAH as an important differential diagnosis in dogs with abrupt postoperative decompensation and supports the value of serial ultrasonography combined with endocrine and electrolyte monitoring.