Ewha Med J.  2014 Dec;37(Suppl):S10-S14. 10.12771/emj.2014.37.S.S10.

Adrenocortical Insufficiency due to Spontaneous Bilateral Adrenal Hemorrhage Presented as Acute Abdominal Pain

  • 1Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea. mdldm@hanmail.net


Adrenocortical insufficiency is the clinical manifestation of deficient production or action of glucocorticoids. It is a life-threatening disorder that can result from primary adrenal failure or secondary adrenal failure due to impairment of the hypothalamic-pituitary axis. Primary adrenocortical insufficiency can be caused by autoimmune adrenalitis, infection (especially, tuberculosis), metastatic cancer, lymphoma, adrenal hemorrhage, infarction or drugs. Among these, adrenal hemorrhage may be caused by anticoagulant drug or heparin therapy, thromboembolic disease, hypercoagulable states such as antiphospholipid syndrome, physical trauma, postoperative state, sepsis and severe stress from any cause. However, even fewer reports exist of adrenocortical insufficiency due to spontaneous bilateral adrenal hemorrhage. We report a rare case of acute adrenocortical insufficiency due to spontaneous bilateral adrenal hemorrhage presenting as acute abdominal pain.


Adrenal insufficiency; Addison disease

MeSH Terms

Abdominal Pain*
Addison Disease
Adrenal Insufficiency
Antiphospholipid Syndrome
Axis, Cervical Vertebra


  • Fig. 1 Patient's tongue shows no hyperpigmentation.

  • Fig. 2 Contrast-enhance abdominal computed tomography (CT). CT scan shows low-attenuation masses in both adrenal glands (arrow).

  • Fig. 3 Abdominal magnetic resonance imaging. Both adrenal masses show high signal intensity (arrow) on T1-weighted image (A) and low signal intensity (arrow) on T2-weighted image (B).

  • Fig. 4 Follow-up contrast-enhanced abdominal computed tomography (CT) after 2 weeks. CT scan shows decreased sizes of both adrenal hematomas. Also noted is rim-enhancement of right adrenal hematoma.


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