HEPARIN-ASSOCIATED THROMBOCYTOPENIA SYNDROME - AN UNDERESTIMATED ETIOLOGY OF ADRENAL HEMORRHAGE

A 74-year-old man developed bilateral arterial thrombosis of the lower limbs related to heparin-associated thrombocytopenia syndrome (HATS). On day 4 after thrombectomy of both limbs, abdominal pain, fever, hyp otension, abdominal tenderness appeared. Acute acalculous cholecystiti s was suspected and cholecystectomy was carried out although the gallb ladder was not imflamed. Later on, hyponatremia in addition to the afo resaid signs suggested the diagnosis of adrenal insufficiency. Diagnos is was confirmed by low cortisol and aldosterone plasma concentration and by CT scan, which showen two enlarged adrenal glands. HATS might e xplain two unexpected facts: occurence of adrenal hemorrhage during he parin therapy with coagulation tests within the therapeutic range and paradoxical thrombosis in the central vein of adrenal gland. HATS must be regarded as one cause of adrenal hemorrhage necrosis.