A patient with heparin-induced thrombocytopenia may have thrombosis with hemorrhagic infarction of one or both adrenal glands. Unilateral injury may go unnoticed while severe bilateral necrosis may be a medical emergency.


Clinical features seen in unilateral or bilateral adrenal hemorrhage with infarction:

(1) heparin therapy

(2) sudden onset of acute flank pain, which may be unilateral or bilateral

(3) fall in platelet counts

(4) low grade fever


With bilateral infarction the patient may develop acute adrenal insufficiency with:

(1) nausea and vomiting

(2) hypotension

(3) agitation


Differential diagnosis:

(1) adrenal hemorrhage from other cause (DIC, sepsis, antiphospholipid syndrome)

(2) retroperitoneal hemorrhage secondary to anticoagulation

(3) adrenal hemorrhage secondary to excessive anticoagulation


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