Journal of Endocrinological Investigation

, Volume 16, Issue 1, pp 61–64 | Cite as

Postoperative primary adrenal failure from bilateral hemorrhagic adrenal infarction associated with coagulation factor XI deficiency

  • R. Wong
  • D. J. Topliss
  • G. L. Metz
  • A. M. Street
Case Report


A 72-year-old man developed bilateral adrenal hemorrhage causing primary adrenal failure three days after total hip replacement, and was found to have coagulation factor XI deficiency. Factor XI deficiency usually causes mild bleeding which is not predictable on the basis of assayable factor XI levels. There have been no previous reports of bilateral adrenal hemorrhage in factor XI de-ficiency or other inherited coagulation factor deficiencies. We suggest that the risk of bilateral adrenal hemorrhage should be considered in any preoperative evaluation of patients with factor XI deficiency.


Adrenal failure adrenal infarction factor XI coagulopathy 


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  1. 1.
    Liu L, Haskin M.E., Rose LI., Bemis CE. Diagnosis of bilateral adrenocortical hemorrhage by computed tomography. Ann. Intern. Med. 97: 720, 1982.PubMedCrossRefGoogle Scholar
  2. 2.
    Albert S.G., Wolverson M.K., Johnson F.E. Bilateral adrenal hemorrhage in an adult. Demonstration by computed tomography. JAMA 247: 1737, 1982.PubMedCrossRefGoogle Scholar
  3. 3.
    Rao R.H., Vagnucci A.H., Amico J.A. Bilateral massive adrenal hemorrhage: early recognition and treatment. Ann. Intern. Med. 110: 227, 1989.PubMedCrossRefGoogle Scholar
  4. 4.
    Alford W.C., Meador C.K., Mihalevich J., Burrus G.R., Glassford D.M., Stoney W.S., Thomas C.S. Acute adrenal insufficiency following cardiac surgical procedures. J. Thorac. Cardiovasc. Surg. 78: 489, 1979.PubMedGoogle Scholar
  5. 5.
    McDonald F.D., Myers A.R., Pardo R. Adrenal hemorrhage during anticoagulant therapy. JAMA 198: 1052, 1966.PubMedCrossRefGoogle Scholar
  6. 6.
    Redman J.F., Faas F.H. Acute unilateral adrenal hemorrhage following ACTH administration in a patient with Cushing’s syndrome. Am. J. Med. 67:533, 1976.CrossRefGoogle Scholar
  7. 7.
    Xarli V.P., Steele A.A., Davis P.J., Buescher E.S., Rios C.N., Garcia-Bunuel R. Adrenal hemorrhage in the adult. Medicine 57: 211, 1978.PubMedCrossRefGoogle Scholar
  8. 8.
    Donowitz G.R., Mandell G. L Beta-lactam antibiotics (2). N. Engl. J. Med. 318:490, 1988.PubMedCrossRefGoogle Scholar
  9. 9.
    Perry-Keene D.A. Bilateral adrenal haemorrhage. Aust. N.Z.J. Med. 22:231, 1992.PubMedCrossRefGoogle Scholar
  10. 10.
    Goulden R.H. Diseases of the supra-renal capsules with the absence of bronze skin. Lancet 2: 266, 1857.CrossRefGoogle Scholar
  11. 11.
    Komesaroff P.A., Yung A.P., Topliss D.J. Postoperative primary adrenal failure in a patient with anticardiolipin antibodies. J. Rheumatol. 18: 88, 1991.PubMedGoogle Scholar
  12. 12.
    Seligsohn U. High gene frequency of factor XI (PTA) deficiency in Ashkenazi Jews. Blood 51: 1223, 1978.PubMedGoogle Scholar
  13. 13.
    Bolton-Maggs P.H.B., Young Wan-Yin B., McCraw A.H., Slack J, Kernoff P.B.A. Inheritance and bleeding in factor XI deficiency. Br. J. Haematol. 69: 521, 1988.PubMedCrossRefGoogle Scholar
  14. 14.
    Roberts H.R., Jones M.R. Hemophilia and related conditions — congenital deficiencies of prothrombin (factor II), factor V and factors VII to XII. In: Williams W.J., Beutler E., Erslev A.J., Lichtman M.A. (Eds.), Hematology. Mc Graw-Hill Publishing Company, New York, ed 4, 1990, p. 1468.Google Scholar
  15. 15.
    Todd M., Wright I.S. Factor XI (P.T.A.) deficiency with no hemorrhagic symptoms. Thromb. Diath. Haemorrh. 11: 186, 1964.PubMedGoogle Scholar
  16. 16.
    Sidi A., Seligsohn U., Jonas P., Many M. Factor XI deficiency: detection and management during urological surgery. J. Urol. 119:528, 1978.PubMedGoogle Scholar
  17. 17.
    Rosenthal R.L., Dreskin O.H., Rosenthal N. Plasma thromboplastin antecedent (PTA) deficien cy: clinical, coagulation, therapeutic & hereditary as pects of a new hemophilia-like disease. Blood 10: 1201, 1955.Google Scholar
  18. 18.
    Bleasel J.F., Rasko J.E.J., Rickard K.A., Richards G. Acute adrenal insufficiency secondary to heparin-in-duced thrombocytopenia-thrombosis syndrome. Med. J. Aust 157: 192, 1992.PubMedGoogle Scholar
  19. 19.
    Kitchens C.S. Factor XI: review of its biochemistry and deficiency. Semin. Thromb. Hemost. 17: 55, 1991.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 1993

Authors and Affiliations

  • R. Wong
    • 1
  • D. J. Topliss
    • 1
  • G. L. Metz
    • 2
  • A. M. Street
    • 3
  1. 1.Ewen Downie Metabolic UnitAlfred HospitalMelbourneAustralia
  2. 2.Department of GastroenterologyAlfred HospitalMelbourneAustralia
  3. 3.Department of HematologyAlfred HospitalMelbourneAustralia

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