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Bilateral Massive Adrenal Hemorrhage

BMAH


Presentation

  • At admission, the man presented with fever, severe hypotension, hyperazotemia, acidosis, normonatremia and hypocoagulability, while the girl with severe hypotension, fever, hyponatremia, and hypocoagulability.[ncbi.nlm.nih.gov]
  • Home » Bilateral Massive Adrenal Hemorrhage: Early Recognition and Treatment SOURCE Annals of Internal Medicine;2/1/89, Vol. 110 Issue 3, p227 SOURCE TYPE Academic Journal ABSTRACT Presents a study that developed a clinical perspective on bilateral massive[connection.ebscohost.com]
  • In this case; despite bilateral massive adrenal hemorrhage, no etiologic factor had been found and adrenal insufficiency was not present.[scopemed.org]
  • Initially, abdominal distention and obstipation are present. Listlessness and fatigue progress to lethargy and disorientation. Tachycardia and hypotension are late signs.[mitchmedical.us]
Turkish
  • ŞENTÜRK, Ayşegül; KILIÇ, Hatice; KARADUMAN-YALÇIN, Funda; HASANOĞLU, Hatice Canan // Turkish Bulletin of Hygiene & Experimental Biology / Türk Hijye;2014, Vol. 71 Issue 1, p35 Addison's Disease that evolved due to infection or caused by autoimmune disease[connection.ebscohost.com]
Thyroid Nodule
  • MORPHOLOGY OF THE PITUITARY 19 THE OPTIC CHIASM IN ENDOCRINOLOGIC 204 PARANEOPLASTIC ENDOCRINE 223 SEX HORMONES AND HUMAN 219 APPROACH TO THE PATIENT WITH 37 ADVERSE EFFECTS OF IODIDE 360 MORPHOLOGY OF THE THYROID 38 NONTOXIC GOITER 366 SYNTHESIS AND 39 THE THYROID[books.google.com]
Goiter
  • MORPHOLOGY OF THE PITUITARY 19 THE OPTIC CHIASM IN ENDOCRINOLOGIC 204 PARANEOPLASTIC ENDOCRINE 223 SEX HORMONES AND HUMAN 219 APPROACH TO THE PATIENT WITH 37 ADVERSE EFFECTS OF IODIDE 360 MORPHOLOGY OF THE THYROID 38 NONTOXIC GOITER 366 SYNTHESIS AND[books.google.com]
Vascular Disease
  • Approach 1668 Zeiher 1676 Gastrointestinal Vascular Diseases 1681 Abolghassem Sepehrnia 1688 Gastrointestinal Vascular Diseases 1695 Paul J DiMuzio 1740 David W P Lappin Hugh R Brady 1751 Percutaneous Approach 1787 Surgical Therapy 1798 Endocrine Vascular[books.google.com]
  • Support for a secondary cause may come from evidence of increased pulmonary capillary/venous pressures, collagen vascular disease, or hemorrhagic disease.[appliedradiology.com]
Hepatosplenomegaly
  • Physicalexamination did not reveal hepatosplenomegaly or lymphadenopa-thy.[documents.tips]
Flushing
  • Causes of Bilateral Adrenal Hemorrhage Anticoagulant Therapy Therapeutic heparin Subtherapeutic heparin Deep venous thrombosis prophylaxis Arterial flush Dialysis Warfarin (Coumadin) Coagulopathy Thrombocytopenia Anticardiolipin antibody Inhibitor of[mitchmedical.us]
Withdrawn
  • Serum cortisol (blood withdrawn every 4 h during 24 h) was low before ( Discussion Before development of CT scan, the diagnosis of bilateral adrenal hemorrhage was seldom recognized before death, because signs and symptoms are nonspecific and are easily[academic.oup.com]

Workup

  • On the other hand, popcorn calcification is essentially diagnostic of a hamartoma and would preclude unnecessary workup.[appliedradiology.com]
Cytopenia
  • Chronic myeloproliferative disorders Adrenal hemorrhage Adrenal insufficiencyIntroductionAdrenal hemorrhage is a heterogeneous entity that occurs in the postoperative period, in the antiphospholip-id-antibody syndrome, in heparin-associated thrombo-cytopenia[documents.tips]
Abnormal Thyroid Function Test
  • THYROID FUNCTION TEST 47 THYROID DISORDERS OF INFANCY 462 P A RT IV CALCIUM AND BONE METABOLISM 473 MORPHOLOGY OF THE PARATHYROID 51 PARATHYROID HORMONE 497 PHYSIOLOGY OF CALCIUM 52 PARATHYROID HORMONERELATED 512 CLINICAL APPLICATION OF BONE MINERAL[books.google.com]

Treatment

  • […] adrenal hemorrhage and an algorithm for its diagnosis and treatment.[connection.ebscohost.com]
  • Therefore, the diagnosis of antiphospholipid syndrome was made, and a warfarin treatment was initiated ( 10 ).[academic.oup.com]
  • . 2001 3 Bilateral massive adrenal hemorrhage. ( 7808087 ) Rao R.H. 1995 4 Bilateral massive adrenal hemorrhage due to sepsis: report of two cases. ( 7699218 ) Piccioli A....Serio M. 1994 5 Bilateral massive adrenal hemorrhage: early recognition and treatment[malacards.org]
  • Abstract Purpose: To develop a clinical perspective on bilateral massive adrenal hemorrhage and an algorithm for its diagnosis and treatment.[annals.org]
  • PURPOSE: To develop a clinical perspective on bilateral massive adrenal hemorrhage and an algorithm for its diagnosis and treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis The prognosis of patients with CIRCI is largely dependent on that of the underlying disease.[clinicaladvisor.com]
  • In spite of treatment with sulphonamides, antibiotics, and steroids, the prognosis is still extremely poor.[intechopen.com]
  • Discussion Metastatic lung cancer carries a dismal prognosis and a high percentage of patients eventually die of progressive disease.[jtd.amegroups.com]
  • […] resection is only indicated in exceptional cases of solitary intracavitary heart metastases, leading to obliteration of cardiac chambers or valve obstruction if the tumor of origin was surgically resected in toto and the patient appears to have a good prognosis[academic.oup.com]

Etiology

  • There are several reasons in etiology and clinical symptoms can vary widely depending on the residual adrenal function.[scopemed.org]
  • This syndrome is associated with a bacteremia, the etiologic agent in the majority of cases being the meningococcus.[nejm.org]
  • Our experience with this unfortunate patient highlights that the physician must be aware of varied etiologies that might cause bilateral adrenal enlargement and must not dwell upon a single pathology to explain all the manifestations of this rare entity[ccij-online.org]
  • Available from: Neonatal adrenal hemorrhage (NAH) is a rare condition with an estimated incidence of 1.9 in 1000 live births. [1] The etiology of the NAH is largely unknown.[sjkdt.org]
  • Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg. 2012 Jan. 36(1):75-82. [Medline]. Diolombi ML, Khani F, Epstein JI.[emedicine.medscape.com]

Epidemiology

  • Until now, these risk factors were not systematically tested using analytical epidemiologic studies. A case-control study was undertaken using sources of cases and controls from multiple teaching hospitals in Ontario, Canada.[ncbi.nlm.nih.gov]
  • Epidemiology There is increasing evidence that in many critically ill patients activation of the HPA axis and the release of cortisol is impaired (AI).[clinicaladvisor.com]
  • Epidemiology Frequency United States Adrenal hemorrhage has been reported in 0.3-1.8% of unselected cases in autopsy studies, although extensive bilateral adrenal hemorrhage may be present in 15% of individuals who die of shock.[emedicine.medscape.com]
  • Clinicopathological study of 30 cases with emphasis on epidemiological and prognostic factors. Pathol Annu. 1992;27(Pt 1):1–53. PubMed Google Scholar 54. Jimenez-Heffernan JA, Hardisson D, Palacios J, Garcia-Viera M, Gamallo C, Nistal M.[link.springer.com]
  • Reversible cerebral vasoconstriction syndrome, part 1: Epidemiology, pathogenesis, and clinical course. Am J Neuroradiol. 2015;36:1392–9. Available from: . View Article PubMed Google Scholar Johnson MW, Kincaid MC, Trobe JD.[jmedicalcasereports.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • The anatomy and physiology of the adrenal gland allow development of a model to fit the pathophysiology behind these risk factors. Until now, these risk factors were not systematically tested using analytical epidemiologic studies.[ncbi.nlm.nih.gov]
  • They reviewed the existing theories of the pathophysiology of adrenal insufficiency in the burn patient. Vaughan and associates demonstrated Cortisol levels three to four times higher than normal in patients with burns greater than 30%.[mitchmedical.us]
  • Pathophysiology The mechanisms leading to inadequate cortisol production during critical illness are complex and poorly understood and likely include decreased production of CRH, ACTH, and cortisol.[clinicaladvisor.com]
  • Pathophysiology: The adrenal cortex produces 3 steroid hormones: glucocorticoids (cortisol), mineralocorticoids (aldosterone, 11-deoxycorticosterone), and androgens (dehydroepiandrosterone).[cushings-help.com]
  • Pathophysiology Although the precise mechanisms leading to adrenal hemorrhage are unclear in nontraumatic cases, available evidence has implicated adrenocorticotropic hormone (ACTH), adrenal vein spasm and thrombosis, and the normally limited venous drainage[emedicine.medscape.com]

Prevention

  • Preemptive steroid therapy and diagnostic evaluation during the precrisis period prevent the occurrence of a potentially disastrous adrenal crisis in a patient who is seriously ill from other problems and who cannot afford a setback of this severity.[ncbi.nlm.nih.gov]
  • Conclusions: Death from bilateral massive adrenal hemorrhage can be prevented by pre-emptive steroid therapy in high-risk patients who have certain clinical and laboratory features. FULL TEXT[annals.org]
  • Heart Institute 1225 Department of Cardiology and Angiology 1235 Therapeutic Options 1240 Erich Donauer Hans Henkes 1265 Neurosurgical Clinic University of Saarland 1281 Surgical Approach 1292 Percutaneous Approach 1302 Peripheral Artery Physiology 1331 Prevention[books.google.com]
  • A diagnosis of bilateral adrenal hemorrhage wasmade, and preemptive steroid therapy to prevent the occurrence ofthe adrenal crisis was started.[documents.tips]

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