Adrenal insufficiency secondary to massive corticomedullary junction hemorrhage following hypotension in three anticoagulated patients

Three patients treated by anticoagulation therapy were found at autopsy to have sustained massive bilateral adrenal hemorrhages. In each instance, an episode of hypotension preceded the onset of the terminal course. In 2 patients death was regarded in retrospect to have probably been attributable to acute Addisonian crisis. Hypotension commonly produces necrosis of the adrenal corticomedullary junction, which normally heals by fibrosis, but in the anticoagulated patient, this necrosis may be complicated by hemorrhage.