SPONTANEOUS IDIOPATHIC BILATERAL ADRENAL APOPLEXY ASSOCIATED WITH HYPERTENSION

Abstract

Although bilateral adrenal hemorrhage has been commonly found at the postmortem examination of a person who died suddenly, it has been associated with meningococcemia or other sepsis,¹ pregnancy,² the neonatal state,³ heparin therapy,⁴ or leukemia.⁵ Standard textbooks refer only to these primary causes.⁶ Unilateral adrenal apoplexy complicating hypertension is also rare but several cases were reported in 1945 by Edelman.⁷ In 1947, McMillan⁸ presented the case of a 60-year-old-white man who was hospitalized because of severe epigastric pain and a blood pressure of 210/110 mm. Hg. The day after his admission, the patient's blood pressure suddenly fell to 96/50, with a weak and irregular pulse, and a high temperature developed. On the third day, the blood pressure dropped to 52/32, and the patient died. Autopsy revealed massive hemorrhage of both adrenal glands and a heart that weighed 500 gm. The arterioles of