Bilateral adrenal hemorrhage resulting in acute adrenal insufficiency as an unusual complication of hepatic arterial chemoembolization

HEPATIC arterial chemoembolization for the treatment of liver metastasis has been used increasingly in patients who are refractory to systemic chemotherapy and/or radiation, or when surgery is not an alternative, as in advanced or multifocal disease. Regional chemotherapy is also of benefit in patients with metastatic primary endocrine tumors, whose symptoms may be directly attributable to release of hormone (1,2). Most patients tolerate this therapy well but do experience some degree of postembolization syndrome, including abdominal pain, nausea, vomiting, and fever. Other complications of hepatic chemoembolotherapy are well documented and include liver necrosis, bile duct stricture, bile leak, progressive hepatic insufficiency, and cholecystitis. We report a case of bilateral adrenal hemorrhage resulting in acute adrenal insufficiency (Addisonian crisis) as an unusual complication of hepatic arterial chemoembolization.