Annals of Hematology

, Volume 98, Issue 10, pp 2421–2423 | Cite as

Acute myeloid leukemia presenting as bilateral adrenal hemorrhage

  • Hadrian MendozaEmail author
  • Nikolai A. Podoltsev
  • Alexa J. Siddon
  • Karthik Gnanapandithan
Letter to the Editor

Dear Editor,

Bilateral adrenal hemorrhage is a rare medical emergency that can result in hypotensive shock and death without prompt treatment [1]. Acute myeloid leukemia (AML) is the most common acute leukemia in adults [2] and is defined by the presence of 20% or more myeloblasts in the marrow or blood [3]. We report here a patient whose initial diagnosis of AML was made following presentation with bilateral adrenal hemorrhage initially without evidence for adrenal insufficiency but later complicated with adrenal crisis.

A 71-year-old female with no significant medical history presented to the emergency department with increasing abdominal pain for 2 days. Her hemoglobin was 9.1 g/dl, platelets were 73 × 10 9/L, and total leukocyte count was 15.2 × 10 9/L with 4% blasts in peripheral blood smear. CT imaging (Fig.  1a, b) and MRI (Fig. 1c, d) of the abdomen revealed bilateral adrenal hemorrhage. There were no clinical features of adrenal insufficiency on presentation; cortisol was...


Compliance with ethical standards

Conflict of interest

NAP consulted for and received honoraria from Alexion, Pfizer, Agios Pharmaceuticals, Blueprint Medicines, Incyte, Novartis; received research funding (all to the institution) from Boehringer Ingelheim, Astellas Pharma, Daiichi Sankyo, Sunesis Pharmaceuticals, Jazz Pharmaceuticals, Pfizer, Astex Pharmaceuticals, CTI BioPharma, Celgene, Genentech, AI Therapeutics, Samus Therapeutics, Arog Pharmaceuticals, Kartos Therapeutics; and received grant funding from Celgene. Other authors (HM, AJS, and KG) report no relevant financial conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from the individual included in this report.


  1. 1.
    Rao RH (1995) Bilateral massive adrenal hemorrhage. Med Clin North Am 79(1):107–129CrossRefGoogle Scholar
  2. 2.
    Yamamoto JF, Goodman MT (2008) Patterns of leukemia incidence in the United States by subtype and demographic characteristics, 1997-2002. Cancer Causes Control 19(4):379–390CrossRefGoogle Scholar
  3. 3.
    Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, le Beau MM, Bloomfield CD, Cazzola M, Vardiman JW (2016) The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 127(20):2391–2405CrossRefGoogle Scholar
  4. 4.
    Dohner H, Estey E, Grimwade D et al (2017) Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood 129(4):424–447CrossRefGoogle Scholar
  5. 5.
    Li W, Okwuwa I, Toledo-Frazzini K, Alhomosh A (2013) Adrenal crisis in a patient with acute myeloid leukaemia. BMJ Case Rep 2013Google Scholar
  6. 6.
    Manganaro L, Al Ansari N, Barchetti F et al (2013) Bilateral adrenal hemorrhage in a patient with myelodysplastic syndrome: value of MRI in the differential diagnosis. Case Rep Radiol 2013:479836Google Scholar
  7. 7.
    Kleanthous A, Koushiappi E, Herodotou Y, Xenofontos E, Vounou E (2014) Acute adrenal insufficiency as a first presentation of myelodysplastic syndrome and sigmoid colon adenocarcinoma: a case report. Oxf Med Case Reports 5:89–92CrossRefGoogle Scholar
  8. 8.
    Lauckner JR, Hebbert FJ (1947) Suprarenal haemorrhage in monocytic leukaemia; with report of a fatal case. Glasgow Med J 28(11):366–377Google Scholar
  9. 9.
    Hubacek J, Hrckova Y, Kopriva P, Krc I (1991) Bleeding to the adrenal gland as a terminal manifestation of acute leukemia. Acta Univ Palacki Olomuc Fac Med 131:297–301Google Scholar
  10. 10.
    Streeten DHP (1996) Adrenal Hemorrhage. Endocrinologist 6(4):277–284CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Laboratory MedicineYale School of MedicineNew HavenUSA
  2. 2.Department of PathologyYale School of MedicineNew HavenUSA
  3. 3.Hematology Section, Department of Internal MedicineYale School of MedicineNew HavenUSA
  4. 4.Department of Internal MedicineYale School of MedicineNew HavenUSA

Personalised recommendations