Adrenal Hemorrhage During Anticoagulant Therapy

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Abstract
Adrenal hemorrhage caused by anticoagulant drugs is seldom diagnosed during life, and heretofore was not studied systematically. An increasing number of case reports suggest that adrenal hemorrhage may be a common and fatal complication of anticoagulant therapy. The 4, 325 adult autopsies performed in a general hospital since the adoption of anticoagulant therapy in 1949 were searched for cases of adrenal hemorrhage. In 9 cases (plus 1 personal case) adrenal hemorrhage occurred during anticoagulant therapy for thromboembolism or myocardial infarction. Five patients received heparin, and 5 heparin plus dicumarol. Adrenal hemorrhage occurred after 2 to 10 days of therapy. Localizing manifestations were steady pain of sudden onset, located to the upper abdomen or flanks, accompanied by tenderness and guarding. Anorexia, nausea and vomiting also occurred. Manifestations of adrenal crisis were listlessness and weakness, progressing to lethargy. Tachycardia, hypotension, fever and cyanosis were late signs. Death occurred in 2 to 8 days. A direct eosinophil count above 50 cells/mm3 may be the most helpful laboratory test for detecting an adrenal crisis. None of the present cases was diagnosed clinically. The diagnosis was made in 3 cases reported previously, and in all 3 prompt and intensive corticosteroid therapy was life - saving.