Adrenal Hemorrhage During Anticoagulant Therapy
Authors: ELIAS AMADOR
Journal: Annals of Internal Medicine (1965)

Article1 October 1965Adrenal Hemorrhage During Anticoagulant TherapyA Clinical and Pathological Study of Ten CasesELIAS AMADOR, M.D.ELIAS AMADOR, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-63-4-559 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAdrenal hemorrhage caused by septicemia is a well-recognized entity (1, 2). Its iatrogenic counterpart produced by anticoagulant therapy may be equally frequent and fatal, as suggested by the increasing number of case reports (3-17). It has not, however, been studied systematically and hence is seldom recognized during life.In this study the clinical course and pathology of iatrogenic adrenal hemorrhage and its frequency relative to that caused by known predisposing disease were defined in a series of consecutive autopsies performed since the adoption of anticoagulant therapy. The clinical manifestations of the 10 cases encountered and of the 20 reported previously...References1. LITTLE EG: Cases of purpura, ending fatally, associated with hemorrhage into the suprarenal capsules. Brit. J. Derm. 13: 445, 1901. CrossrefGoogle Scholar2. ANDREWES FW: A case of acute meningococcal septicemia. Lancet 1: 1172, 1906. CrossrefGoogle Scholar3. VERDONK GJ: Bijnierapoplexie bij een met Heparine Behandelde Patiënte. Nederl. T. Geneesk. 91: 2409, 1947. Google Scholar4. MERZAUFDERMAUR WRA: Nebennierenapoplexie bei heparinverabreichung. Schweiz. Med. Wschr. 82: 590, 1952. Google Scholar5. THORNGOLDFIENNELSON GWADH: The treatment of adrenal dysfunction. Med. Clin. N. Amer. 40: 1270, 1956. CrossrefGoogle Scholar6. MOOLTEN SE: Symmetrical hemorrhagic necrosis of the adrenal glands complicating coronary thrombosis. J. Mount Sinai Hosp. NY 24: 1042, 1957. MedlineGoogle Scholar7. CHOKAS WV: Bilateral adrenal hemorrhage complicating dicoumarol therapy for myocardial infarction. Amer. J. Med. 24: 454, 1958. CrossrefMedlineGoogle Scholar8. DECOURTMICHARD JJP: Insuffisance surrénale aigüe, puis chronique, installé brutalement au cours d'un traitement par l'héparine. Bull. Soc. Méd. Paris 76: 422, 1960. MedlineGoogle Scholar9. FRAGGEBERNSTEINBELL RGILJ: Fatal "Waterhouse-Friderichsen" syndrome due to dicumarol. Ann. Intern. Med. 52: 923, 1960. LinkGoogle Scholar10. DOMARTWOLFROMMHAZARD ARJ: Une cause exceptionelle d'insuffisance surrénale: l'hemorragie bilaterale des capsules surrénales au cours de traitement anticoagulant. Presse Méd. 69: 489, 1961. MedlineGoogle Scholar11. ARENDS A: Bijnierbloeding. Nederl T. Geneesk. 105: 1073, 1961. MedlineGoogle Scholar12. GUERNELLILONDEI ND: Considerazioni patogenetiche sull'apoplessia surrenalica "spontanea." Bull. Sci. Med. (Bologna) 133: 313, 1961. MedlineGoogle Scholar13. HARPERGINNTAYLOR JRWMWJ: Bilateral adrenal hemorrhage—a complication of anticoagulant therapy. Case report and review of the literature. Amer. J. Med. 32: 984, 1962. CrossrefMedlineGoogle Scholar14. CASTLEMANKIBBEE BBU: Case records of the Massachusetts General Hospital. Case No. 52-1962. New Eng. J. Med. 267: 300, 1962. CrossrefGoogle Scholar15. KNIGHTVALENTINE LLEH: Spontaneous bilateral adrenal hemorhage. Report of a case occurring during heparin therapy. JAMA 182: 1312, 1962. CrossrefMedlineGoogle Scholar16. BOTTERIORELL ASR: Adrenal hemorrhage and necrosis in the adult. A clinicopathological study of 23 cases. Acta Med. Scand. 175: 409, 1964. CrossrefMedlineGoogle Scholar17. MILLERCEBALLOS RER: Anticoagulant therapy as a cause of bilateral adrenal necrosis. Alabama J. Med. Sci. 1: 404, 1964. MedlineGoogle Scholar18. WRIGHTMARPLEBECK ISCDDF: Report of the committee for the evaluation of anticoagulants in the treatment of coronary thrombosis with myocardial infarction. Amer. Heart J. 36: 801, 1948. CrossrefMedlineGoogle Scholar19. CRANE C: Use of heparin-gelatin-dextrose in venous thrombosis and pulmonary embolism. New Eng. J. Med. 245: 926, 1951. CrossrefMedlineGoogle Scholar20. RAYER P: Recherches anatomico-pathologiques sur les capsules surrénales. L'Experience (Paris) 1: 17, 1837. Google Scholar21. ARNAUD F: Les hémorragies des capsules surrénales. Arch. Gén. Méd. 4: 5, 1900. Google Scholar22. CRANE C: Deep venous thrombosis and pulmonary embolism. Experience with 391 patients treated with heparin and 126 patients treated by venous division, with review of the literature. New Eng. J. Med. 257: 147, 1957. CrossrefMedlineGoogle Scholar23. THORN GW: Studies on pituitary adrenal relationships. Trans. Amer. Clin. Climat. Ass. 60: 168, 1948. MedlineGoogle Scholar24. FALOONREYNOLDSBEEBE WWRWRT: Use of direct eosinophil count in diagnosis and treatment of Waterhouse-Friderichsen syndrome. New Eng. J. Med. 242: 441 1950. CrossrefGoogle Scholar25. LIPSETTPEARSON MBOH: Pathophysiology and treatment of adrenal crisis. New Eng. J. Med. 254: 511, 1956. CrossrefMedlineGoogle Scholar26. D'AGATIMARANGONI VCBA: The Waterhouse-Friderichsen syndrome. New Eng. J. Med. 232: 1, 1945. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: ELIAS AMADOR, M.D.Affiliations: Boston, MassachusettsFrom the Departments of Pathology, Peter Bent Brigham Hospital and Harvard Medical School, Boston, Mass.Requests for reprints should be addressed to Elias Amador, M.D., Peter Bent Brigham Hospital, 721 Huntington Ave., Boston, Mass. 02115. 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PORTNAY, M.D., APOSTOLOS G. VAGENAKIS, M.D., LEWIS E. BRAVERMAN, M.D., F.A.C.P., SERGIO I. CERVI-SKINNER, M.D.THE LABORATORY CONTROL OF HEPARIN THERAPYHemothoraxExperimentelle Nebennierenrindenblutungen an anticoagulierten Ratten, ausgel�st durch Stimulation der NebennierenrindeDisseminated Intravascular Coagulation [ Abridged ]Orale AntikoagulantienTherapeutic implications of disseminated intravascular coagulationHypercalcaemia in Addison's Disease 1 October 1965Volume 63, Issue 4Page: 559-571KeywordsAnticoagulant therapyAutopsyClinical pathologyCorticosteroid therapyHemorrhageHypotensionLaboratory testsNauseaSepsisTachycardia ePublished: 1 December 2008 Issue Published: 1 October 1965 PDF downloadLoading ...