RAPID RECOVERY FROM ADRENAL INSUFFICIENCY DUE TO BILATERAL ADRENAL HEMORRHAGE

Most patients with adrenal insufficiency require lifelong glucocortico id or glucocorticoid and mineralocorticoid replacement. Feuerstein and Streeten [1] first reported complete recovery of adrenal function in a patient with adrenal insufficiency after post-traumatic bilateral ad renal hemorrhage. We report a patient who rapidly recovered from adren al insufficiency associated with post-operative anticoagulant-induced bilateral adrenal hemorrhage. A 35-year-old white male in excellent he alth sustained major left facial, rib, and pelvic trauma in a tractor accident. After surgical repair of pelvic fractures he was prophylacti cally anticoagulated with low dose coumadin. Seven days later he devel oped subacute onset of fatigue, nausea, lightheadedness, generalized w eakness, and decreased mentation. Supine blood pressure, pulse, serum electrolytes, glucose, and his prothrombin time were normal. CT scan o f his abdomen revealed bilateral adrenal enlargement, and MRI scan T2- weighted images were consistent with the presence of adrenal fluid. Hi s baseline 9 a.m. cortisol was 4.6 mu g/dL. (normal, 7-25) and failed to rise with cosyntropin (synthetic ACTH 1-24) stimulation. CT-guided right adrenal gland fine needle aspiration revealed hemorrhagic fluid. Hydrocortisone sodium succinate 300 mg/day IV resulted in marked impr ovement within 24 hours. Nine months later he completely discontinued cortisol replacement without adverse effect. This case illustrates tha t patients with adrenal insufficiency due to bilateral adrenal hemorrh age may rapidly recover adrenal function.