Abstract
Bilateral adrenal hemorrhage is a rare but life-threatening condition that can result in adrenal insufficiency. We present the case of a 63-year-old man who developed bilateral adrenal hemorrhage following a fall from 3 feet height on a ladder. He fell backwards, striking his lower back on the adjacent dry wall and landed on the ground. He was admitted for a traumatic L1 burst fracture and was treated with T11-L3 fusion and T12-L3 laminectomy. Postoperatively, he received prophylactic subcutaneous unfractionated heparin and later developed unexplained tachycardia, pulmonary embolism, and bilateral adrenal masses. He was subsequently readmitted with altered mental status, hypotension, and profound electrolyte abnormalities. Laboratory evaluation revealed undetectable cortisol and elevated adrenocorticotropic hormone (ACTH), consistent with primary adrenal insufficiency. Imaging confirmed hyperdense bilateral adrenal masses. Infectious causes were excluded, and heparin-induced thrombocytopenia was ruled out. The patient was treated with intravenous hydrocortisone, leading to rapid clinical improvement. He was discharged on oral steroid therapy and remains well on follow-up. This case highlights the importance of considering bilateral adrenal hemorrhage in postoperative patients presenting with nonspecific symptoms and hemodynamic instability.