ESPE Abstracts

Introduction: Bilateral adrenal hemorrhage is a rare pathology, contrary to what happens with unilateral ones. It is more common in newborns and associated with situations of perinatal hypoxia, sepsis, traumatic births, or coagulation abnormalities. The classic triad includes jaundice, anemia, and a flank mass, which can lead to severe shock. Extensive bilateral hemorrhage is required to produce a situation of adrenal insufficiency. The diagnosis is made by imaging techniques (ultrasound or CT) and requires ruling out the different causes mentioned. Treatment is usually supportive (fluid therapy, phototherapy, transfusions and replacement therapy).

Case report: Two pediatric patients with acute abdominal pain are presented. Both required admission to the Pediatric Intensive Care Unit (PICU). The diagnosis was adrenal insufficiency with bilateral adrenal mass was noted on imaging test.

Patient 1: A 10-year-old girl with no important medical history. She started with symptoms of high fever, abdominal pain, weakness and vomiting. On physical examination general condition was affected and she showed signs of peritoneal irritation. A blood test was performed showing signs of infection. Abdominal ultrasound and CT showed image of mesenteric infarction and bilateral adrenal mass. She was admitted to Intensive Care Unit with arterial hypotension and hyponatremia. Due to the suspicion of adrenal insufficiency, blood tests were taken with data of primary adrenal insufficiency. Therapy with stress-dose hydrocortisone was started. She does not require surgical intervention. Coagulation study and infectious screening were normal. Currently, after one year, she maintains hydrocortisone at a replacement dose due to primary adrenal insufficiency.

Patient 2: A-10-year-old boy with a medical history of primary autoimmune thrombocytopenia. Clinic of 2 weeks of evolution of weakness, abdominal pain, headache and vomiting. He shows signs of dehydration and peritoneal irritation. With the suspicion of acute abdominal pain, blood test were performed with no signs of infection and showed hyponatremia, thrombocytopenia and coagulopathy. Abdominal ultrasound and CT showed image of mesenteric ischemia and bilateral adrenal mass. He was admitted to the Intensive Care Unit, blood tests were extracted showing data of primary adrenal insufficiency, and treatment with stress-dose hydrocortisone was started. Anticoagulant lupus in coagulation study. Good evolution with replacement dose of hydrocortisone and anticoagulation.

Conclusion: In the presence of abdominal pain of unknown etiology, clinical suspicion is important to detect adrenal insufficiency in patient with risk factors or suggestive data in imaging test.