From oral anticoagulants to prednisone

  • Mihai Cristian Dumitrascu UMF ` Carol Davila` Bucharest & Department of Obstetrics&Gynecology University Emergency Hospital Bucharest, Romania
  • Florica Sandru UMF ”Carol Davila”& Department of Dermatology, Elias University Emergency Hospital, Bucharest
  • Mara Carsote UMF ` Carol Davila` Bucharest & Department of Endocrinology ` C.I. Parhon` National Institut of Endocrinology Bucharest, Romania, Romania
Keywords: adrenal haemorrhage, adrenal insufficiency, adrenal complication

Image Description

This is a 55-year, non-smoker female, admitted to the emergency room for acute adrenal insufficiency. She progressively presented for the last several months a tendency to low blood pressure, weight loss, in addition to asthenia, hyperpigmentation of the face and hands. The medical records revealed arterial hypertension, thrombosis at the left popliteal artery (thrombectomy 3 years prior) and deep vein thrombosis at left leg a few years before; she received rivaroxaban for the last 3 years.

She was treated with hydrocortisone hemisuccinate (300 mg within the first day of admission with progressive dose reduction) then a daily regime with 7.5 mg prednisone and fludrocortisone 0.05 mg. Lifetime monitoring of the dose is required.

Initially, hormonal panel was consistent with the clinical diagnostic revealing an adrenal etiology: increased ACTH (Adrenocorticotropic Hormone) 6 times above normal and very low plasma cortisol. Concerning the cause of primary adrenal insufficiency, computed tomography identified bilateral adrenal haemorrhage with enlargement of both adrenal glands with tumor-like aspect, irregular shape, heterogeneous structures with hypodense areas (of necrosis), of 2.3/2.1/2.9 cm (right), respective of 3.2/5.7/3.2 cm (left). (Figure 1 and 2– Computed tomography: different sections of transversal plan showing bilateral adrenal haemorrhage)

Therapy with oral anticoagulants might complicate an adrenal–related life-threatening situation, especially if other risk factors are positive like: pro-thrombotic status, thrombocytopenia, anti-phospholipidic syndrome, active cancers or infections [1].  Early recognition and therapy are mandatory for survival.

References

Laslo CL, et al. New oral anticoagulants - possible extension to other indications (Review). Exp Ther Med. 2020;20(3):2401-2405.

Published
2022-01-16
How to Cite
Dumitrascu, M., Sandru, F., & Carsote, M. (2022). From oral anticoagulants to prednisone. Medical Image Database, 4(1), 31-32. https://doi.org/10.33695/mid.v4i1.104
Section
Articles