Bilateral massive adrenal hemorrhage due to sepsis: report of two cases

Two cases (a 57-year-old man and an 18-year-old girl) of bilateral massive adrenal hemorrhage (BMAH) due to sepsis (Streptococcus pneumoniae and Neisseira meningitidis, respectively) are reported. At admission, the man presented with fever, severe hypotension, hyperazotemia, acidosis, normonatremia and hypocoagulability, while the girl with severe hypotension, fever, hyponatremia, and hypocoagulability. A diagnostic protocol based on a very quick method for cortisol measurement is proposed, in an attempt to reach an earlier diagnosis of BMAH during sepsis.