(244) Bilateral Adrenal Hemorrhage as a Complication of Heparin-Induced Thrombocytopenia

Introduction: Heparin-induced thrombocytopenia (HIT) is a rare but well-documented phenomenon associated with the administration of heparin. While HIT is recognized for its potential to cause thrombosis, complications such as adrenal hemorrhage are rarely reported. Adrenal hemorrhage leading to adrenal insufficiency can be life-threatening if not promptly recognized.

Description: A 65-year-old male with a history of hypertension and hyperlipidemia underwent lumbar fixation, fusion, and laminectomy following a traumatic fall. Postoperative recovery was uncomplicated and prophylactic enoxaparin therapy was initiated for four days. Twelve days postoperatively, the patient returned to the hospital with symptoms of diffuse abdominal pain, fatigue, nausea, and vomiting. Laboratory analysis revealed severe hyponatremia, thrombocytopenia, low cortisol levels, and abnormal coagulation parameters. Subsequent testing confirmed the presence of HIT antibodies. A computed tomography (CT) scan demonstrated bilateral adrenal enlargement. Treatment with corticosteroids and fludrocortisone was initiated, and the endocrine surgery and interventional radiology services were consulted. Urgent magnetic resonance imaging (MRI) was performed revealing bilateral 3 cm adrenal gland hematomas and concurrent thrombosis involving the infrahepatic inferior vena cava, renal, and portal veins. The patient received inpatient management for eleven days, resulting in stabilization of platelet counts and adrenal function. Upon discharge, the patient was transitioned to oral apixaban therapy without further complications.

Discussion: This case emphasizes that while HIT is acknowledged for its association with thrombotic complications, adrenal hemorrhage remains an underreported, potentially fatal complication. The nonspecific presentation of HIT necessitates a high index of suspicion to avoid delayed diagnosis. Confirmation of adrenal hemorrhage can be achieved through a combination of CT imaging and serum cortisol assessment. Early detection and medical management are paramount to preventing adverse outcomes. Awareness of this rare complication is crucial for clinicians to ensure timely intervention and avoid potentially lethal outcomes.