Anticoagulants
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Adrenal haemorrhage with Addisonian crisis and thrombocytopenia: case report A 68-year-old woman developed adrenal haemorrhage with Addisonian crisis while receiving phenprocoumon, fondaparinux sodium, rivaroxaban and heparin. She also developed thrombocytopenia while receiving treatment with heparin [dosage and routes not stated]. The woman was hospitalised with three days history of nausea, vertigo, bilateral flank pain and vomiting. She had undergone total knee prosthesis eleven days prior to the presentation. She had been receiving phenprocoumon for atrial fibrillation, which was stopped prior to the procedure. Heparin was started during the procedure. Few days after the procedure, she again started receiving phenprocoumon. Three days prior to the admission, she started receiving piperacillin/tazobactam for aspiration pneumonia. At admission, her examination showed lethargy, apyrexy, hypotension, tachycardia and painless palpation of left knee with swelling. Lab tests showed hypocortisolism, hypokalemia and hyponatraemia. An abdominal CT scan showed hyperdense oval enlargement of the adrenal glands, which was consistent with acute adrenal haemorrhages. She also developed severe anaemia, without any signs of blood loss and Addisonian crisis. Her hemoglobin improved. Platelet factor 4 antibody was positive. She was also diagnosed with HIT. Hence, heparin was replaced with fondaparinux sodium. At discharge, fondaparinux sodium was again changed to rivaroxaban. She was again admitted with acute flank pain, hyponatremia, hypotension and adrenal bleeding. She suspected to have Addisonian crisis as the acute manifestation of primary adrenal insufficiency. The woman was treated with phenprocoumon, and phenprocoumon was stopped. She was transferred to the ICU. She was treated with fluid resuscitation and norepinephrine. She also received fludrocortisones. Her condition improved. At follow-up, unilateral adrenal haemorrhages had resolved. Five months after the first diagnosis of primary adrenal insufficiency, she was again admitted to the ICU with Addisonian crisis due to an influenza-infection with fever. She received high-dose of hydrocortisone and fluid resuscitation. She was discharged in improved condition. Jensen AB, et al. Rare Bilateral Adrenal Haemorrhage with Addisonian Crisis: When Risk Factors Come in Droves. Case Reports in Endocrinology 2020: 8886537, Jan 2020. 803504056 Available from: URL: http://doi.org/10.1155/2020/8886537
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Reactions 3 Oct 2020 No. 1824
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