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Bilateral adrenal haemorrhage — SCE Endocrinology MCQ

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HardAdrenalBilateral adrenal haemorrhageSCE Endocrinology

A 46-year-old man with antiphospholipid syndrome presents with abdominal pain, fever and shock. CT abdomen shows bilateral adrenal enlargement with haemorrhage. Sodium is 124 mmol/L, potassium is 6.1 mmol/L and glucose is 2.9 mmol/L. What is the most likely biochemical finding?

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Correct answer: E — Very high ACTH with low cortisol

Bilateral adrenal haemorrhage can cause acute primary adrenal insufficiency, producing low cortisol and markedly elevated ACTH. Suppressed ACTH would suggest exogenous or autonomous cortisol excess, not adrenal destruction. The pearl is that bilateral adrenal structural injury can present as adrenal crisis.

Reference: Society for Endocrinology adrenal crisis guidance