Adrenal insufficiency as a late consequence of massive honeybee exposure

Adrenal insufficiency may be a delayed complication of near-fatal massive honeybee envenomation and may play a role in immediate fatal events, according to David Robinson, MD, of the department of Asthma, Allergy and Clinical Immunology at Virginia Mason Medical Center, Seattle, WA.

He noted that evaluations of massive envenomation events have not commonly shown an increased risk for adrenal insufficiency. But he described a case of a 77-year-old woman and her 80-year-old husband who lived part of the year in Bolivia, where they had long kept hives of Africanized honeybees. Neither showed evidence of bee sting hypersensitivity in the past.  While tending their hive in a remote area, both were exposed to a massive number of stings (he >600, she >200) and barely survived. 

Both husband and wife wondered if they had become sensitized as a result of that event. After discharge from the hospital in Bolivia, she began to experience lethargy and was hospitalized again in Seattle with nausea, vomiting, and eosinophilia.  Abdominal CT scans showed bilateral adrenal enlargement/masses.  According to Dr. Robinson, evaluation showed evidence of adrenal insufficiency; she has responded to replacement therapy.  Subsequent abdominal CT scans showed shrinkage and involution of both adrenal glands. Both husband and wife were evaluated for stinging insect hypersensitivity and found to be allergic only to honey bee venom. They have begun desensitization.