Endocrine Abstracts

Adrenal haemorrhage is a rare but clinically significant condition, presenting as unilateral or bilateral. Common underlying causes are trauma, sepsis, anticoagulation, and adrenal tumours. This condition is critical and can precipitate adrenal insufficiencies/crisis. Here, we compare cases of bilateral versus unilateral presentations of adrenal haemorrhage; highlighting differences in their aetiology, clinical presentation, and management strategies. Case 1: 70-year-old male with known previous stroke, hypertension, AF (not on anticoagulation) and COPD, presented with flank pain, urinary sepsis and refractory hypotension. Abdominal CT imaging revealed bilateral adrenal thickening. Dedicated CT adrenal confirmed bilateral adrenal haemorrhages. 9am cortisol 61nmol/l, ACTH 14ng/l, low aldosterone <60 pmol/l, high renin 16.8nmol/L/h - suggesting primary adrenal insufficiency, with normal sodium (144mmol/l) and potassium (5.0mmol/l). The 1 mg overnight-dexamethasone suppression cortisol was normal (35nmol/l). He was commenced on hydrocortisone cover. Repeat imaging in five months showed resolution of the adrenal haemorrhage. Currently, he is being reviewed in the endocrine clinic and has persistently low aldosterone levels. He continues hydrocortisone and fludrocortisone therapy and is scheduled for further tests to assess his adrenal reserve. Case 2: 82-year-old male on anticoagulation therapy and heart failure medications, presented with a fall and hypotension. He was found to have unilateral adrenal haemorrhage on CT abdomen. CT adrenal showed an adrenal lesion consistent with hematoma. 9am cortisol was 319nmol/l, sodium 140mmol/L and potassium 4.4mmol/l, i.e. adequate adrenal function. Although clinically stable, this patient requires close endocrine monitoring to assess lesion functionality and exclude malignancy, with follow-up imaging scheduled to confirm resolution 3 months after diagnosis. Both cases explore the challenges in diagnosing adrenal haemorrhage due to its nonspecific symptoms and emphasise the need for targeted imaging and endocrine evaluation. Unilateral haemorrhage with no adrenal insufficiency often stabilises with conservative management; whereas bilateral haemorrhage needs vigilant monitoring and potential lifelong adrenal steroid cover.