Acute adrenal insufficiency as a first presentation of myelodysplastic syndrome and sigmoid colon adenocarcinoma: a case report

Abstract

Acute adrenal failure due to bilateral adrenal haemorrhage is rare and may initially present with non-specific symptoms. It can rapidly progress into a life-threatening condition if not diagnosed promptly. Both traumatic and non-traumatic conditions have been implicated in the aetiology, with the latter been even rarer. We describe the case of a 57-year-old woman presenting with vomiting and epigastric pain and later developing fever and diarrhoea. The patient then deteriorated into shock and primary adrenal insufficiency was identified. A computed tomography scan noted bilateral adrenal haemorrhage. Further investigations showed a sigmoid colon adenocarcinoma and a myelodysplastic syndrome, with monosomy seven. Bilateral non-traumatic adrenal haemorrhage is an infrequent finding and investigating its aetiology can be challenging. In our patient, two simultaneous underlying diseases were identified. To the best of our knowledge, the combination of these two non-traumatic conditions as a cause of acute bilateral adrenal haemorrhage has not been previously reported.

Figure 1:

Computer tomography imaging: a transverse contrast-enhanced computed tomography image showing bilateral adrenal enlargement (white arrows), without particular contrast uptake. Maximum diameter 23 mm (left adrenal gland). These findings are consistent with bilateral adrenal haemorrhage.

Figure 2:

Magnetic resonance imaging: performed on Day 7 (subacute phase) (a) Transverse view of a T1-weighted image of the adrenals demonstrating high signal in the periphery (b) Transverse plane of a T2-weighted image showing high signal intensity in the adrenals particularly on the left side (c) Coronal view of a contrast-enhanced image displaying heterogeneous hyperintensity without contrast uptake, excluding metastatic infiltration.