Bilateral Adrenal Hemorrhage with Adrenal Insufficiency After Dalteparin Use Post HIP Athroplasties
ABSTRACT: Objective: Multiple case reports have implicated the use of heparin for deep vein thrombosis (DVT) prophylaxis with bilateral adrenal hemorrhage. Only 1 previous report has described this with the low molecular weight product, dalteparin. We report a case following bilateral hip arthropla...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-05-01
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| Series: | AACE Clinical Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S237606052030016X |
| _version_ | 1818563157943123968 |
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| author | Robyn L. Houlden, MD, FRCPC Azraa Janmohamed |
| author_facet | Robyn L. Houlden, MD, FRCPC Azraa Janmohamed |
| author_sort | Robyn L. Houlden, MD, FRCPC |
| collection | DOAJ |
| description | ABSTRACT: Objective: Multiple case reports have implicated the use of heparin for deep vein thrombosis (DVT) prophylaxis with bilateral adrenal hemorrhage. Only 1 previous report has described this with the low molecular weight product, dalteparin. We report a case following bilateral hip arthroplasties. Methods: Clinical and laboratory data are presented. Results: A 69-year-old woman underwent bilateral total hip arthroplasties with dalteparin 5,000 international units subcutaneously daily for 30 days postoperatively. The patient's past medical history was unremarkable. She was discharged 5 days post-surgery and required readmission 1 day later for epigastric pain, nausea, and vomiting. Her platelet count was 91 × 109/L (normal, 150 to 400 × 109/L). She was discharged after 4 days with pain resolution. She presented 4 weeks later with nausea and vomiting for several days. Serum sodium was 123 mmol/L (normal, 133 to 145 mmol/L), potassium was 6.0 mmol/L (normal, 3.7 to 5.3 mmol/L), total calcium was 3.37 mmol/L (normal, 2.25 to 2.80 mmol/L), creatinine was 404 μmol/L (normal, 0 to 85 μmol/L), and her platelet count was normal. On short adrenocorticotropic hormone stimulation test, baseline plasma cortisol was 123 nmol/L and the peak was 129 nmol/L. She was treated with hydrocortisone, fludrocortisone, and 0.9% saline with resolution of symptoms and normalization of electrolytes, calcium, and renal function. Computed tomography showed bilateral adrenal masses. Core needle biopsy was consistent with necrosis. There were no bleeding disorders on hematologic work 3 months later. The most likely etiology of bilateral adrenal hemorrhage was heparin-induced thrombocytopenia from dalteparin. Conclusion: This case highlights the importance of vigilance for the complication of bilateral adrenal hemorrhage with adrenal insufficiency in patients receiving dalteparin for DVT prophylaxis. |
| first_indexed | 2024-12-14T01:13:09Z |
| format | Article |
| id | doaj.art-c08e7090b99b402fb93c912216e4f034 |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-14T01:13:09Z |
| publishDate | 2020-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-c08e7090b99b402fb93c912216e4f0342022-12-21T23:22:41ZengElsevierAACE Clinical Case Reports2376-06052020-05-0163e141e143Bilateral Adrenal Hemorrhage with Adrenal Insufficiency After Dalteparin Use Post HIP AthroplastiesRobyn L. Houlden, MD, FRCPC0Azraa Janmohamed1Address correspondence to Dr. Robyn Houlden, Division of Endocrinology, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.; From the Department of Medicine, Queen's University, Kingston, Ontario, Canada.From the Department of Medicine, Queen's University, Kingston, Ontario, Canada.ABSTRACT: Objective: Multiple case reports have implicated the use of heparin for deep vein thrombosis (DVT) prophylaxis with bilateral adrenal hemorrhage. Only 1 previous report has described this with the low molecular weight product, dalteparin. We report a case following bilateral hip arthroplasties. Methods: Clinical and laboratory data are presented. Results: A 69-year-old woman underwent bilateral total hip arthroplasties with dalteparin 5,000 international units subcutaneously daily for 30 days postoperatively. The patient's past medical history was unremarkable. She was discharged 5 days post-surgery and required readmission 1 day later for epigastric pain, nausea, and vomiting. Her platelet count was 91 × 109/L (normal, 150 to 400 × 109/L). She was discharged after 4 days with pain resolution. She presented 4 weeks later with nausea and vomiting for several days. Serum sodium was 123 mmol/L (normal, 133 to 145 mmol/L), potassium was 6.0 mmol/L (normal, 3.7 to 5.3 mmol/L), total calcium was 3.37 mmol/L (normal, 2.25 to 2.80 mmol/L), creatinine was 404 μmol/L (normal, 0 to 85 μmol/L), and her platelet count was normal. On short adrenocorticotropic hormone stimulation test, baseline plasma cortisol was 123 nmol/L and the peak was 129 nmol/L. She was treated with hydrocortisone, fludrocortisone, and 0.9% saline with resolution of symptoms and normalization of electrolytes, calcium, and renal function. Computed tomography showed bilateral adrenal masses. Core needle biopsy was consistent with necrosis. There were no bleeding disorders on hematologic work 3 months later. The most likely etiology of bilateral adrenal hemorrhage was heparin-induced thrombocytopenia from dalteparin. Conclusion: This case highlights the importance of vigilance for the complication of bilateral adrenal hemorrhage with adrenal insufficiency in patients receiving dalteparin for DVT prophylaxis.http://www.sciencedirect.com/science/article/pii/S237606052030016X |
| spellingShingle | Robyn L. Houlden, MD, FRCPC Azraa Janmohamed Bilateral Adrenal Hemorrhage with Adrenal Insufficiency After Dalteparin Use Post HIP Athroplasties AACE Clinical Case Reports |
| title | Bilateral Adrenal Hemorrhage with Adrenal Insufficiency After Dalteparin Use Post HIP Athroplasties |
| title_full | Bilateral Adrenal Hemorrhage with Adrenal Insufficiency After Dalteparin Use Post HIP Athroplasties |
| title_fullStr | Bilateral Adrenal Hemorrhage with Adrenal Insufficiency After Dalteparin Use Post HIP Athroplasties |
| title_full_unstemmed | Bilateral Adrenal Hemorrhage with Adrenal Insufficiency After Dalteparin Use Post HIP Athroplasties |
| title_short | Bilateral Adrenal Hemorrhage with Adrenal Insufficiency After Dalteparin Use Post HIP Athroplasties |
| title_sort | bilateral adrenal hemorrhage with adrenal insufficiency after dalteparin use post hip athroplasties |
| url | http://www.sciencedirect.com/science/article/pii/S237606052030016X |
| work_keys_str_mv | AT robynlhouldenmdfrcpc bilateraladrenalhemorrhagewithadrenalinsufficiencyafterdalteparinuseposthipathroplasties AT azraajanmohamed bilateraladrenalhemorrhagewithadrenalinsufficiencyafterdalteparinuseposthipathroplasties |