Bilateral adrenal hemorrhage (BAH) is a rare but potentially catastrophic condition. Its clinical manifestation is often non-specific and sometimes difficult to be diagnosed in time. A 57-year-old woman, who presented with severe fatigue, nausea and vomiting after left hip arthroplasty due to her femoral neck fracture in a local hospital, was transferred to our medical center. Laboratory results revealed significant hyponatremia, low serum cortisol and elevated serum ACTH. Computed tomography (CT) showed a bilateral adrenal mass, measured 3.6 × 2.7 cm on the left and 3.4 × 2.3 cm on the right. Further magnetic resonance imaging (MRI) confirmed the diagnosis of BAH. The patient was prescribed with oral prednisolone acetate, 5 mg, tid, and her condition improved gradually. Nine months after, the patient was in good condition with 5 mg prednisolone acetate per day. CT revealed a clearly shrunken adrenal mass compared with 9 months ago. This case illustrates the difficulty in making the diagnosis of BAH with atypical presentation. Such cases necessitate greater alertness on the part of the clinician and require rapid diagnosis and prompt glucocorticoid replacement for better clinical outcomes.

中文翻译：

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髋关节置换术后双侧肾上腺出血：最初被误诊的病例

双边肾上腺出血（BAH）是一种罕见但潜在的灾难性疾病。其临床表现通常是非特异性的，有时难以及时诊断。一名57岁的女性因她的股骨颈骨折而在左髋关节置换术后出现严重的疲劳，恶心和呕吐，该患者被转移到我们的医疗中心。实验室结果显示明显的低钠血症，低血清皮质醇和升高的血清ACTH。计算机断层扫描（CT）显示双侧肾上腺肿块，左侧为3.6×2.7 cm，右侧为3.4×2.3 cm。进一步的磁共振成像（MRI）证实了BAH的诊断。患者口服醋酸泼尼松龙5 mg，每日两次，病情逐渐好转。九个月后 病人每天服用5 mg泼尼松龙的状况良好。与9个月前相比，CT显示肾上腺肿块明显缩小。该病例说明了非典型表现诊断BAH的困难。此类病例需要临床医生提高警觉性，并且需要快速诊断并及时更换糖皮质激素以取得更好的临床效果。