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Recovery of Adrenal Function after Failure Resulting from Traumatic Bilateral Adrenal Hemorrhages

Barbara Feuerstein, MD; and David H.P. Streeten, MB, DPhil
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Grant Support: By Clinical Research Center Grant RR229 from the Division of Research Facilities and Resources, United States Public Health Service.

Requests for Reprints: David H.P. Streeten, MB, DPhil, SUNY Health Science Center, 750 East Adams Street, Syracuse, NY 13210.

Current Author Addresses: Dr. Feuerstein: Community General Hospital Physicians Office Building, Syracuse, NY 13215.

Dr. Streeten: SUNY Health Science Center, 750 East Adams Street, Syracuse, NY 13210.

Ann Intern Med. 1991;115(10):785-786. doi:10.7326/0003-4819-115-10-785
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Massive bilateral adrenal hemorrhage causing adrenal insufficiency, shock, and death has been recognized at autopsy for many years. Such hemorrhages may result from acute meningococcal and other bacterial septicemias (especially in children), thromboembolic disease, the therapeutic use of anticoagulants, surgical and other forms of "stress," and severe trauma (1-6). The autopsy results from 5 of 60 patients who died after closed thoracic, abdominal, or pelvic injuries, showed bilateral adrenal hemorrhages. Severe bilateral hemorrhages have usually been fatal if they were unrecognized and untreated (7). Adrenal insufficiency in survivors has usually been permanent and has required continued steroid-replacement therapy (4). We


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