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Reference | Comuth et al. [2] | Lavoipierre [3] | Arosemena et al. [4] | Sanford et al. [5] | Bakhsh et al. [6] | DiCenso et al. [7] | Aneke and Gunendran [8] | Godfrey et al. [9] |
Gender | Female | Male | Male | Male | Female | Male | Female | Female |
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Age (years) | 63 | 47 | 46 | 42 | 40 | 46 | 53 | 68 |
Triple positive | Yes | Yes | NA | NA | NA | NA | NA | NA |
Prior warfarin use | No | No | No | Yes | No | Yes | Current | Current |
Type of DOAC | Rivaroxaban | Apixaban | Rivaroxaban | Apixaban | Rivaroxaban | Rivaroxaban | Warfarin | Warfarin |
Duration of AC prior to admission | 5 months | 2 months | Few months | 1 month | 2 weeks | Unknown | 7 years | Unknown |
Clinical manifestations | LUQ abdominal pain, vomiting | Abdominal pain, livedo reticularis | Abdominal pain, nausea, weight loss | Fever, right flank pain | Severe RUQ pain, nausea | Abdominal pain, syncope | Nausea, vomiting, fever, rigors, R flank pain | Bilateral loin pain, vomiting, fever, confusion |
Laboratory findings | K of 4.2 mmol/L and Na of 137 mmol/L | | Na of 121 mmol/L, K of 5.4 mmol/L | NA | Renal function test reported normal | Na of 121 mmol/L, K of 5.5 mmol/L, random cortisol of 0.8 mcg/dL (22 nmol/L) | Na of 122, cortisol of 1.4 mcg/dL (40 nmol/L) | Na of 132, cortisol of 1.7 mcg/dL (48 nmol/L) |
CT findings | Dilatation of both adrenal glands | Bilateral adrenal hematomas | Bilateral adrenal hemorrhage | Right-sided adrenal hemorrhage | Enlargement of the right adrenal gland | Thickening of the adrenal glands | Bilateral adrenal hemorrhage | Bilateral heterogenous adrenal pathology |
MRI findings | Unknown | Unknown | T1 signal in the region of bilateral adrenal glands | Unknown | Unknown | T1 hyper-intensity of the bilateral adrenal glands | No | No |
ACTH stimulation | Positive | Positive | NA | NA | NA | NA | NA | NA |
Treatment | Methylpred 40 mg IV-switched to HC (dose/duration unknown) | HC + fludrocortisone | HC 50 mg q 6 hr + fludrocortisone 0.1 mg daily | Unknown | Methylpred 1.5 mg/kg | HC 50 mg IV every 8 hours | IV HC | IV HC 100 mg q 6 h->switched to oral HC + fludrocortisone |
Medication upon discharge | Unknown | HC + fludrocortisone | HC 15 mg in AM and 10 mg in PM fludro 0.1 mg daily | Unknown | Unknown | HC + fludrocortisone | Oral HC-reducing doses to reach target dose: 10 mg AM, 5 mg noon, 5 mg night | HC + fludrocortisone |
Anticoagulation upon discharge | Dalteparin 15.000 IE daily-switched to warfarin after a month (unknown target INR) | Warfarin | Warfarin (unknown target INR) | Warfarin (target INR 2.5–3.5) | Warfarin (target INR 2–2.5) | Unknown | Fondaparinux-switched back to warfarin after 5 days | Unknown |
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