Several case reports have been filed regarding the latent presentation of hemorrhagic pheochromocytomas in the trauma setting; however, few patients have been found to exhibit these symptoms in the absence of a tumor. In this report, we discuss a patient who sustained blunt abdominal trauma leading to the development of an adrenal hemorrhage and his unexpected sequelae of symptoms. Discovery of the source of the patient's symptoms was delayed secondary to multiple comorbidities in the critical care setting and work-up for other sources such as infection and agitation. Hypertensive urgency was confirmed to be of adrenal etiology with measurement of persistently elevated plasma and urine metanephrines during the hospital course. The patients hypertensive urgency was successfully managed with the use of antisympathomimetics including an esmolol drip, clonidine, and eventually tapered dose of metoprolol. Symptoms improved over time, and repeat CT imaging weeks later showed resolution of the hematoma. Review of literature reveals only one other case of adrenal hemorrhage after blunt force trauma resulting in hemorrhagic psuedotumor. To our knowledge, this is the second such case ever presented. This case is discussed along with the presentation, diagnostic work-up, and treatment of a critically ill patient with an adrenal hemorrhage masked as a pseudotumor.

Massive bilateral adrenal hemorrhage occurring in the postoperative period is an unusual but potentially life-threatening complication of any abdominal operation. The diagnosis is often difficult due to the nonspecific nature of the clinical presentation, which is easily attributable to other more common postoperative conditions. We report a case of bilateral adrenal hemorrhage resulting in acute primary adrenal insufficiency following an otherwise-uncomplicated laparoscopic cholecystectomy, which has not previously been described. An awareness of the possibility of this uncommon condition complicating laparoscopic cholecystectomy may lead to a higher index of suspicion, which is important in timely diagnosis and prompt treatment.

Adrenal gland insufficiency – the clinical manifestation of deficient production or action of adrenal steroids – is a life-threatening disorder. Among many factors which can predispose to primary adrenal failure, an autoimmune adrenalitis and infectious agents play a major role. The initial host defense against bacterial infections is executed primarily by the pattern recognition receptors, e.g. Toll-like receptors (TLRs), expressed in cells from the innate immune system. Upon activation, TLRs have been found to regulate various levels of innate and adaptive immunity as well as control tissue inflammation. TLRs are implicated in adrenal cell turnover and steroidogenesis during inflammation. Therefore, TLRs play a crucial role in the activation of adrenal inflammation mediating adrenal gland dysfunction during septicemia. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Adrenal gland insufficiency – the clinical manifestation of deficient production or action of adrenal steroids – is a life-threatening disorder. Among many factors which can predispose to primary adrenal failure, an autoimmune adrenalitis and infectious agents play a major role. The initial host defense against bacterial infections is executed primarily by the pattern recognition receptors, e.g. Toll-like receptors (TLRs), expressed in cells from the innate immune system. Upon activation, TLRs have been found to regulate various levels of innate and adaptive immunity as well as control tissue inflammation. TLRs are implicated in adrenal cell turnover and steroidogenesis during inflammation. Therefore, TLRs play a crucial role in the activation of adrenal inflammation mediating adrenal gland dysfunction during septicemia. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.