Heparin-associated thrombocytopenia syndrome : an underestimated etiology of adrenal hemorrhage

A 74-year-old man developed bilateral arterial thrombosis of the lower limbs related to heparin-associated thrombocytopenia syndrome (HATS). On day 4 after thrombectomy of both limbs, abdominal pain, fever, hypotension, abdominal tenderness appeared. Acute acalculous cholecystitis was suspected and...

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Bibliographic Details
Published in:Intensive care medicine 1993-08, Vol.19 (8), p.475-477
Main Authors: DELHUMEAU, A, MOREAU, X, CHAPOTTE, C, HOUI, N, BIGORGNE, J. C
Format: Article
Language:English
Subjects:
Adrenal Gland Diseases - etiology
Aged
Biological and medical sciences
Drug toxicity and drugs side effects treatment
Hemorrhage - etiology
Heparin - adverse effects
Humans
Male
Medical sciences
Miscellaneous (drug allergy, mutagens, teratogens...)
Pharmacology. Drug treatments
Syndrome
Thrombocytopenia - chemically induced
Thrombocytopenia - complications
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Summary:A 74-year-old man developed bilateral arterial thrombosis of the lower limbs related to heparin-associated thrombocytopenia syndrome (HATS). On day 4 after thrombectomy of both limbs, abdominal pain, fever, hypotension, abdominal tenderness appeared. Acute acalculous cholecystitis was suspected and cholecystectomy was carried out although the gallbladder was not imflamed. Later on, hyponatremia in addition to the aforesaid signs suggested the diagnosis of adrenal insufficiency. Diagnosis was confirmed by low cortisol and aldosterone plasma concentration and by CT scan, which showen two enlarged adrenal glands. HATS might explain two unexpected facts: occurrence of adrenal hemorrhage during heparin therapy with coagulation tests within the therapeutic range and paradoxical thrombosis in the central vein of adrenal gland. HATS must be regarded as one cause of adrenal hemorrhage necrosis.
ISSN:0342-4642
1432-1238
DOI:10.1007/bf01711091