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Case Reports
. 2019 Nov 4;19(1):106.
doi: 10.1186/s12894-019-0536-7.

Bilateral adrenal hemorrhage after hip arthroplasty: an initially misdiagnosed case

Lei Wang  1   2 , Xiao-Fei Wang  1   2 , Ying-Chao Qin  3 , Jia Chen  1   2 , Cun-Hai Shang  4 , Guo-Feng Sun  1   2 , Ning-Chen Li  5   6   7
Affiliations
Case Reports

Bilateral adrenal hemorrhage after hip arthroplasty: an initially misdiagnosed case

Lei Wang et al. BMC Urol. .

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. 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.

Keywords: Anticoagulants; Arthroplasty; Bilateral adrenal hemorrhage; Case report; Glucocorticoid replacement; Stress.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Axial computed tomography scan abdominal (postoperative day 12) revealed a bilateral adrenal mass with mixed high density
Fig. 2
Fig. 2
Enhanced computed tomography (coronal section) on postoperative day 26 showed a bilateral adrenal mass, measured 3.6 × 2.7 × 4.8 cm on the left and 3.4 × 2.3 × 4.2 cm on the right, with enhancement only seen in peripheral area of the mass
Fig. 3
Fig. 3
Magnetic resonance imaging (axial section, T2 weighed) on postoperative day 33 displayed water signal intensity of long T2 in central regions of bilateral adrenal mass
Fig. 4
Fig. 4
Enhanced magnetic resonance imaging (postoperative day 140) revealed a clearly shrunken adrenal mass compared with 3 months ago
Fig. 5
Fig. 5
CT scan (9 months after discharge) revealed a continuously shrunken adrenal mass, measured 1.4 × 0.9 cm on the left and 1.3 × 0.9 cm on the right, compared with 9 months ago
See this image and copyright information in PMC

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