cosyntropin and Hemorrhage

BACKGROUND Direct oral anticoagulant (DOAC) agents, such as rivaroxaban, treat and prevent venous thrombosis. Although adrenal hemorrhage due to DOACs has previously been reported, this is a rare condition that can present as an emergency. In this case report, we present a 65-year-old man who recently had bilateral knee arthroplasty and was started on rivaroxaban 10 mg daily for deep vein thrombosis (DVT) prophylaxis following the surgery. CASE REPORT Ten days after bilateral knee arthroplasty and starting rivaroxaban, the patient presented to the Emergency Department with severe, sudden abdominal pain. Abdominal computed tomography detected significantly enlarged bilateral adrenals, with ill-defined heterogeneous density extending to the upper part of perinephric and paranephric spaces, suggesting bilateral adrenal hemorrhage. A cosyntropin stimulation test was used to confirm the suspicion of adrenal insufficiency. Cortisol levels were 66 nmol/L before stimulation and 83 nmol/L 60 min after cosyntropin administration. Hydrocortisone was started intravenously at a dose of 50 mg every 8 h. After his symptoms improved, he was discharged on oral hydrocortisone at 10 mg in the morning and 5 mg in the evening. Seven weeks after discharge, follow-up abdominal ultrasonography showed that the bilateral adrenal hemorrhage had resolved. CONCLUSIONS This case supports previous cases of adrenal hemorrhage as a rare but serious association with rivaroxaban and highlights the importance of rapid diagnosis using imaging and monitoring of patients for this possible adverse effect. Practitioners must remain vigilant when prescribing anticoagulation therapy, especially in patients who are at an increased risk for adrenal hemorrhage.

Topics: Aged; Anticoagulants; Cosyntropin; Hemorrhage; Humans; Hydrocortisone; Male; Rivaroxaban; Venous Thrombosis

Many spontaneous adrenal hematomas have been observed in patients being treated by Synacthène. The purpose of this study is to define how to take those patients in charge on a short-, mid- and long-term.. From January 2000 to December 2008, five patients (four males and one female), mean age 47, were taken in charge in our service for spontaneous adrenal hematomas. All those patients had been treated with Synacthène for a mid-sciatic pain for 72 hours. We associated a clinical, endocrine and radiologic staging to treat those patients.. Four patients underwent a watchful waiting, only one patient needed surgery. No adrenal tumor was ever found during the mean two years follow-up (one to four). Two patients suffered of the condition of the antiphospholipid syndrome.. Spontaneous adrenal hematomas are a most uncommon pathology. The clinical attitude has thus to be defined clearly. The patient must be under close clinical evaluation. Biological and morphological parameters have to be often repeated. An adrenal tumor has to be excluded by the evaluation, as that tumor could be secreting or could not be secreting. Antiphospholipid syndrome must also be excluded.

Topics: Adrenal Gland Diseases; Adult; Aged; Cosyntropin; Decision Trees; Female; Hematoma; Hemorrhage; Hormones; Humans; Male; Middle Aged; Retrospective Studies

Topics: Adrenal Gland Diseases; Cosyntropin; Hemorrhage; Humans; Postoperative Complications; Tomography, X-Ray Computed

Topics: Acute Disease; Adrenal Gland Diseases; Adrenal Insufficiency; Age Factors; Cosyntropin; Diagnosis, Differential; Hemorrhage; Hemorrhagic Disorders; Humans; Male; Middle Aged; Pulmonary Embolism; Spleen; Splenectomy; Subphrenic Abscess; Tomography, X-Ray Computed

Among 26,462 carefully monitored medical inpatients, 24, or 0.9 per 1,000, were considered to have died as a result of a drug or group of drugs. Most of the patients were seriously ill prior to the event that caused death. Six of the deaths-five from fluid overload and one from excessive potassium therapy-may have been preventable.

Topics: Adolescent; Adult; Aged; Anaphylaxis; Asthma; Cerebral Hemorrhage; Cosyntropin; Drug Therapy; Drug-Related Side Effects and Adverse Reactions; Female; Hemorrhage; Heparin; Hospitalization; Humans; Iatrogenic Disease; Male; Methods; Middle Aged; Pharmaceutical Preparations; Pulmonary Embolism; Streptodornase and Streptokinase; Thrombophlebitis; United States