Acute adrenocortical insufficiency due to heparin-induced thrombocytopeniawith subsequent bilateral haemorrhagic infarction of the adrenal glands

A 56 year old male developed bilateral massive adrenal haemorrhage (BMAH) r esulting in chronic adrenal insufficiency in the course of heparin-induced thrombocytopenia (HIT)-syndrome. Thrombosis of the central adrenal vein (CA V) with subsequent adrenal haemorrhagic infarction is the most probable cau se of the rare association of HIT and BMAH. The exorbitantly high catechola mine plasma levels within the CAV in addition to immunogenic platelet activ ation are discussed as possible underlying pathophysiological mechanisms.