Bilateral adrenal hemorrhage due to sepsis resulting in acute adrenal crisis.

摘要

A 77-year-old woman was admitted to our hospital with dysarthria and difficulty in walking on May 28, 2004. As brain CT scan revealed multiple low-density areas, lacunar cerebral infarction was diagnosed. Dysarthria and difficulty in walking were resolved by conservative therapy and rehabilitation. The patient then experienced a sudden rise in body temperature and Klebsiella pneumoniae was found in a blood sample collected from a peripheral artery on June 9. Although the patient was treated with antibiotics and gamma globulin for sepsis, no response was observed. After that she suffered septic shock and loss of consciousness (JCS III-300). Her blood pressure did not respond to the administration of dopamine or norepinephrine, and she died on June 12. During this history, no other symptoms of adrenal failure, such as anorexia, fatigue, nausea, vomiting, progressive hyponatremia or hyperkalemia were observed. However, her serum cortisol level was relatively low: 14.5 |ig/dl on the morning on June 12. Macroscopic (Fig. 1) and histological findings (Fig. 2) were consistent with bilateral adrenocortical hemorrhage.