Adrenal failure secondary to bilateral adrenal haemorrhage in heparin-induced thrombocytopenia
Heparin-induced thrombocytopenia (HIT) is a clinical syndrome caused by the formation of antibodies against the platelet factor 4 (PF4)-heparin complex associated with heparin therapy . Antibody binding results in platelet activation and elaboration of pro-thrombotic mediators, which underpin the dual clinical manifestation of thrombocytopenia and thrombosis in HIT, classically between 5 and 14 days following heparin exposure . Notably, thrombosis of the adrenal vasculature paradoxically leads to adrenal haemorrhage, which is a rare but classical presentation of HIT . In such circumstances, two important clinical issues arise: firstly, strategies for therapeutic anticoagulation in the face of significant haemorrhage and secondly the risk of ensuing adrenal crisis, which requires urgent hormone replacement therapy .
The authors acknowledge the contribution of Dr. Kevin Zhou (Radiology Advanced Trainee, Monash Health) in preparing the radiological images displayed in this work.
AT, MS and MSYL drafted the manuscript and prepared the figures for submission. All authors were directly involved in the patient’s care. JG, AL and MSYL reviewed the manuscript and all authors approved the final version of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Written informed consent has been obtained from the patient for publication of this work.
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