Adrenal insufficiency in a patient with severe hypotension caused by bilateral adrenal hemorrhage.

OBJECTIVE

To describe a patient with adrenal insufficiency and bilateral adrenal enlargement and to review causes of adrenal insufficiency, with special emphasis on adrenal hemorrhage.

METHODS

We present the clinical course of a woman with apparent septic shock, who responded poorly to treatment with inotropic agents. The possible cause and management of such cases are discussed.

RESULTS

A 44-year-old woman with no prior major illness required medical attention because of severe hypotension, volume depletion, acute renal failure, and shock. Numerous laboratory and radiologic studies were performed to determine the cause of her shock state. She did not respond to several inotropic agents. When she was found to have adrenal insufficiency, initiation of treatment with glucocorticoids promptly alleviated her hypotension.

CONCLUSION

Critically ill patients who have sudden unexplained hypotension that does not respond to supportive management should be screened for adrenal insufficiency. The current patient emphasizes the importance of considering this disorder in the differential diagnosis of hypotension that is unresponsive to pressor agents.