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Patousis A, Patousis P, Barbakis G, Sachinis NP. Bilateral Adrenal Hemorrhage Following Femoral Hip Hemiarthroplasty: A Case Report. Cureus 2022; 14:e27748. [PMID: 36106217 PMCID: PMC9447475 DOI: 10.7759/cureus.27748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/05/2022] Open
Abstract
Bilateral adrenal hemorrhage (BAH) is a rare and potentially fatal complication following total hip arthroplasty and low-molecule heparin use for DVT-prophylaxis. We present a case of a 64-year-old woman who sustained a femoral neck fracture, which was addressed with hip hemiarthroplasty. Twelve days postoperatively DVT was diagnosed and therapeutic doses of low-molecule-heparin were administered. The next day, CTPA was done searching for pulmonary embolism but BAH was shown and a short synacthen test confirmed the diagnosis of adrenal insufficiency. A therapeutic protocol with hydrocortisone was followed.
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Wang L, Wang XF, Qin YC, Chen J, Shang CH, Sun GF, Li NC. Bilateral adrenal hemorrhage after hip arthroplasty: an initially misdiagnosed case. BMC Urol 2019; 19:106. [PMID: 31684918 PMCID: PMC6829824 DOI: 10.1186/s12894-019-0536-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022] Open
Abstract
Background Bilateral adrenal hemorrhage (BAH) is a rare but potentially catastrophic condition. Its clinical manifestation is often non-specific and sometimes difficult to be diagnosed in time. Case summary A 57-year-old woman, who presented with severe fatigue, nausea and vomiting after left hip arthroplasty due to her femoral neck fracture in a local hospital, was transferred to our medical center. Laboratory results revealed significant hyponatremia, low serum cortisol and elevated serum ACTH. Computed tomography (CT) showed a bilateral adrenal mass, measured 3.6 × 2.7 cm on the left and 3.4 × 2.3 cm on the right. Further magnetic resonance imaging (MRI) confirmed the diagnosis of BAH. The patient was prescribed with oral prednisolone acetate, 5 mg, tid, and her condition improved gradually. Nine months after, the patient was in good condition with 5 mg prednisolone acetate per day. CT revealed a clearly shrunken adrenal mass compared with 9 months ago. Conclusions This case illustrates the difficulty in making the diagnosis of BAH with atypical presentation. Such cases necessitate greater alertness on the part of the clinician and require rapid diagnosis and prompt glucocorticoid replacement for better clinical outcomes.
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Affiliation(s)
- Lei Wang
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Health Science Center, Beijing, 100144, China
| | - Xiao-Fei Wang
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Health Science Center, Beijing, 100144, China
| | - Ying-Chao Qin
- Department of General Surgery, Shuangqiao Hospital in Chaoyang District, Beijing, 100024, China
| | - Jia Chen
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Health Science Center, Beijing, 100144, China
| | - Cun-Hai Shang
- Department of Medical Imaging, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China
| | - Guo-Feng Sun
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.,Peking University Wu Jieping Urology Center, Peking University Health Science Center, Beijing, 100144, China
| | - Ning-Chen Li
- Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China. .,Peking University Wu Jieping Urology Center, Peking University Health Science Center, Beijing, 100144, China. .,Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, 9# Jinyuanzhuang Road, Shijingshan District, Beijing, 100144, China.
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