BES2002 Poster Presentations Clinical Case Reports (60 abstracts)
A diagnostic trilemma of primary adrenal failure, sepsis and HITTS
LA O'Shea 1 , C McHugh 1 , O O'Gorman 1 , F Regan 2 , H Enright 3 & JM Barragry 1
1Department of Endocrinology, Adelaide & Meath Hospitals incorporating the National Hospital for Sick Children, Tallaght, Dublin, Ireland; 2Department of Radiology, Adelaide & Meath Hospitals incorporating the National Hospital for Sick Children, Tallaght, Dublin, Ireland; 3Department of Haematology, Adelaide & Meath Hospitals incorporating the National Hospital for Sick Children, Tallaght, Dublin, Ireland.
We report the case of a forty nine year old housewife who developed life-threatening acute adrenal failure. She was 3 weeks post-hysterectomy & had received prophylactic anticoagulation perioperatively. 2 weeks posthysterectomy she developed pleuritic chest pain. Low molecular weight heparin (LMWH) was started.V/Q lung scan proved negative for pulmonary embolism. A week later she represented in a hypotensive, hypoxic state with signs of infection and pulmonary embolism. CT thorax/abdomen showed a right pulmonary artery thrombus, left basal pneumonia & enlarged cystic adrenals. LMWH was recommenced with antibiotics & steroids. A falling platelet count to a nadir of 64 by day 5 & rising heparin requirements suggested HITTS confirmed on platelet aggregation test & isolation of IgG antibody. Hirudin therapy was initiated with prompt recovery. At 4 months, our patient has persistent adrenal failure (2nd Synacthen test) & resolving bilateral haematomas (2nd CT scan).We wish to draw attention to Heparin-induced Thrombocytopenia & Thrombosis Syndrome a rare, reversible but potentially fatal condition caused by LMW & unfractionated heparin associated with thrombotic & haemorrhagic sequelae & an uncommonly acute adrenal failure.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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