title: Bilateral adrenal infarction, hypoadrenalism and splinter haemorrhages in the 'primary' antiphospholipid syndrome.
abstract: We describe a patient with a 3-year history of recurrent deep vein thromboses (DVT) of the lower limbs, who developed adrenal insufficiency following withdrawal of warfarin therapy. Multiple splinter haemorrhages of the nail beds were evident, simultaneous with the development of adrenal infarction in the absence of infective endocarditis. CT scans of the adrenal glands were consistent with bilateral adrenal infarctions. The patient had persistently high titres of IgG anticardiolipin antibodies (aCL) over the previous 4 years in the absence of antinuclear antibodies (ANA), antibodies to double stranded deoxyribonucleic acid (dsDNA) or extractable nuclear antigens (ENA). Thrombocytopenia and an intermittently positive Coombs' test had been noted. Previous episodes of DVT were associated with inadequate warfarin control and a period of warfarin resistance. He conforms to a diagnosis of a 'primary' antiphospholipid syndrome.
authors.affiliation: Department of Rheumatology, St Thomas' Hospital, London.
authors.forename: D E
authors.initials: DE
authors.lastname: Ames
authors.forename: R A
authors.initials: RA
authors.lastname: Asherson
authors.forename: B
authors.initials: B
authors.lastname: Ayres
authors.forename: J
authors.initials: J
authors.lastname: Cassar
authors.forename: G R
authors.initials: GR
authors.lastname: Hughes
mesh_terms: D000307:Adrenal Gland Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications*; D006471:Gastrointestinal Hemorrhage / Q000150:complications*; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D007238:Infarction / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D009260:Nail Diseases / Q000150:complications*; D012007:Rectum; D013924:Thrombophlebitis / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D014859:Warfarin