Bilateral adrenal hemorrhage during ACTH treatment of ulcerative colitis

Adrenal hemorrhage is uncommon and usually associated with severe stress, sepsis, or anticoagulant therapy. The association of adrenal hemorrhage and acute ulcerative colitis is rare, and is probably related to exogenous therapy with ACTH. The case of a 29-year-old woman who was hospitalized with severe ulcerative colitis, treated with ACTH, and who developed bilateral adrenal hemorrhage is presented. The difficulties of diagnosis and management are discussed. A review of the relevant literature concerning the pathophysiology of adrenal hemorrhage is presented also.