Bilateral hemorrhage into the adrenal glands is a potentially lethal c
ondition that must be recognized and treated immediately if the patien
t is to survive. Recognition is hampered by the fact that clinical sig
ns are vague and laboratory abnormalities are not diagnostic. A high i
ndex of suspicion maintained in a patient with the appropriate risk pr
ofile, and aggressive treatment with steroids as soon as the diagnosis
is suspected, will ensure survival. Subsequent hormonal and anatomic
confirmation should be followed by life-long steroid therapy, since co
mplete adrenal destruction is the norm.