背景:肾上腺出血(AH)是一种罕见的疾病,可导致危及生命的医疗紧急情况。这种疾病可能是由几个潜在因素引起的,其中之一是使用抗凝剂。据我们所知,直接口服抗凝剂(DOAC)是AH的罕见但可能的原因。
方法:这里,我们描述了两例由于DOAC引起的AH。第一例是一名35岁的伊朗妇女,有桥本甲状腺炎病史,由于先前的血栓形成,正在接受阿哌沙班治疗。她最初的AH症状(2021年11月)与自身免疫性Addison病(AAD)的症状奇怪地相似,后者导致2型自身免疫性多内分泌综合征(APS-2)的确诊。腹部MRI显示一个椭圆形的囊性肿块,直径20×14毫米,左侧肾上腺有一个厚而低的信号强度边缘,高度怀疑亚急性左侧AH。我们的第二个病例是一名89岁的伊朗妇女,她因低血压和迷失方向而入院(2021年8月)。在她入院之初,评估显示低钠血症,进一步评估证实肾上腺功能不全(AI)。患者报告在股骨固定手术后使用利伐沙班预防深静脉血栓形成。她的腹部CT扫描显示双侧肾上腺肿块高度提示AH。她的随访检查显示三个月后持续的AI。
结论:鉴于我们的病例病史,医生应该意识到接受DOAC的患者的AH,尤其是在出血风险高的老年患者中。还值得注意的是,AH可以发生在任何有任何病史和DOAC使用史的患者中,这就是为什么必须密切监测患者。
BACKGROUND: Adrenal hemorrhage (AH) is a rare condition that can result in a life-threatening medical emergency. This medical condition could be caused by several underlying factors, one of which is the use of anticoagulants. As far as we are aware, direct oral anticoagulant (DOAC) agents are a rare but possible cause of AH.
METHODS: Herein, we described two cases of AH due to DOACs. The first
case was a 35-year-old Iranian woman with a past medical history of Hashimoto thyroiditis who was being treated with apixaban due to the previous thrombosis. Her first symptoms of AH (November 2021) were strangely similar to symptoms of autoimmune Addison disease (AAD) which led to a confirmed diagnosis of autoimmune polyendocrine syndrome type 2 (APS-2). An abdominal MRI revealed an oval shape well-encapsulated cystic mass with a diameter of 20 × 14 mm with a thick and low signal intensity rim in the left adrenal gland, highly suggestive of sub-acute left-sided AH. Our second
case was an 89-year-old Iranian woman who had been admitted to the hospital (August 2021) with low blood pressure and disorientation. At the beginning of her admission, the evaluation showed hyponatremia, and further evaluations confirmed adrenal insufficiency (AI). The patient reported rivaroxaban usage for deep vein thrombosis prophylaxis after femur fixation surgery. Her abdominal CT scans showed bilateral adrenal masses highly suggestive of AH. Her follow-up examination showed persistent AI after three months.
CONCLUSIONS: Given the history of our cases, physicians should be aware of AH in patients receiving DOACs, particularly in elderly patients who are at high risk of bleeding. It is also worth noting that AH can occur in any patient with any medical history and history of DOAC use, which is why patients must be closely monitored.