Case Report
Bilateral Adrenal Hemorrhage and Adrenal Insufficiency in the Context of Polycythemia Vera: A Case Report and Review of the Literature
Table 2
Summary of studies reported adrenal hemorrhage in the context of polycythemia vera.
| | Authors | Sex | Age (years) | Presenting symptoms | Laboratory data and physical findings | CT findings | Patient management | Patient outcome |
| | Bhandari et al. [8] | Male | 64 | (i) Unresponsiveness | (i) Hypotension (BP: 72/43 mmHg)
(ii) Tachycardia
(iii) Fever (T: 38.8°C)
(iv) Hypoglycemia (blood sugar: 38 mg/dl)
(v) Leukocytosis
(vi) Acute kidney injury
(vii) Hyperkalemia
(viii) Elevated troponin
(ix) Elevated coagulation indices
(x) Random cortisol: 3.3 mcg/dl | Bilateral adrenal hemorrhage:
(i) Right adrenal: 5.3 3.4 3.8 cm
(ii) Left adrenal: 6.1 4.3 5.4 cm | Stress dose of hydrocortisone (100 mg) | Undertreatment of primary adrenal insufficiency | | Gonen et al. [5] | Male | 56 | (i) Nausea
(ii) Vomiting
(iii) Epigastric pain
(iv) Loss of appetite | (i) Hematocrit: 62%
(ii) Leukocytosis
(iii) Blood glucose: 65 mg/dl
(iv) Basal plasma cortisol: <138 nmol/l
(v) ACTH: 550 pmol/l
(vi) Splenomegaly | Bilateral adrenal masses:
(i) Right adrenal: 4 5 5.5 cm
(ii) Left adrenal: 4 3 2 cm | Prednisolone | Fully disappearance of adrenal lesions after 2 years | | Gelfand et al. [7] | Male | 85 | (i) Abdominal tenderness
(ii) Syncope
(iii) Severe chest and abdominal pain | (i) Platelet: 538 109/l
(ii) Hematocrit: 0.45
(iii) Red cells: 5.7 10/l
(iv) White blood cells: 15 10/l
(v) Normal cortisol | Bilateral high-attenuating homogenous adrenal masses | NA | NA |
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CT: computed tomography, BP: blood pressure, ACTH: adrenocorticotropic hormone, and NA: not available.
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