Bilateral Adrenal Infarction as an Uncommon Complication of Heparin-Induced Thrombocytopenia: A Case Report

BACKGROUND Heparin-induced thrombocytopenia (HIT) is an immune-mediated reaction that occurs 5-10 days after heparin exposure. Antibodies against platelet factor 4 (PF4) activate platelets and lead to a hypercoagulable state, causing thrombotic complications, including deep venous thrombosis, pulmonary embolism, stroke, and myocardial infarction. Given the widespread use of prophylactic heparin in clinical practice, prompt recognition and management are crucial due to the associated high morbidity and mortality. CASE REPORT A 73-year-old woman with hypertension, hypothyroidism, depression, and anxiety presented with 6 days of nausea, vomiting, abdominal pain, constipation, weakness, and postural dizziness. She recently underwent cervical spine surgery and received prophylactic heparin. Laboratory findings showed normocytic anemia, mild leukocytosis, new-onset thrombocytopenia, and hyponatremia. Further evaluation revealed low morning cortisol, positive PF4 antibodies, and serotonin release assay (SRA), consistent with HIT. CT demonstrated bilateral adrenal enlargement and peripheral fat stranding, confirming adrenal infarction. Discontinuation of heparin and treatment with rivaroxaban, intravenous steroids, and hemodynamic support led to significant improvement. CONCLUSIONS HIT-induced adrenal infarction is uncommon and often overlooked due to its nonspecific presentation. This case emphasizes the importance of suspecting adrenal involvement in patients with prior heparin exposure and hypotension or electrolyte imbalance. Prompt anticoagulant adjustment, steroid replacement, and follow-up with hemodynamic monitoring can improve clinical outcomes.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Peer-reviewed clinical and outcomes research relevant to anticoagulation, leech therapy, and microsurgical flap management. Indexed in PubMed and verified against the NCBI record.

Leech-derived molecules this paper discusses, each with a full profile in the ASH compound registry:

Узнайте, как это исследование связано с клинической практикой

More peer-reviewed studies in Клинические исследования.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• HIRUDOTHERAPY IN PRESBYACUZIS PRAECOX IN CLEAN-UP WORKERS AFTER THE CHORNOBYL ACCIDENT DURING THE POST-CATASTROPHE YEARS — Zabolotnyi D, Mishchanchuk N (2019)
• Wound healing potential of bark paste of Pongamia pinnata along with hirudotherapy: A case report — Balasooriya D, Karunarathna C, Uluwaduge I (2021)
• AIF-1 and RNASET2 Play Complementary Roles in the Innate Immune Response of Medicinal Leech — Baranzini N et al. (2019)
• Study on the effect of medicinal leech therapy (Hirudo medicinalis) on full-thickness excisional wound healing in the animal model — Zakian A et al. (2022)
• [Hirudo medicinalis-leech applications in plastic and reconstructive microsurgery--a literature review] — Knobloch K et al. (2007)
• The duration of rest and feeding greatly affects the re-breeding of ectoparasites: Hirudo verbana, Hirudo medicinalis and Hirudo orientalis — Aminov R, Frolov A, Aminova A (2022)
• Recombinant hirudin in clinical practice: focus on lepirudin — Greinacher A, Lubenow N (2001)

Browse all ASH-analysed research →