[Bilateral adrenal hemorrhage occurring two times in primary antiphospholipid syndrome (APS). Anticoagulation as treatment of hemorrhage].
METHODS
A 56-year-old man was admitted for investigation of abdominal pain radiating to the back. The patient was known to suffer from APS and autoimmune thrombocytopenia, and was therefore treated with oral anticoagulants. The clinical examination was normal.


METHODS
Ultrasound detected an area with low echogenicity in the region of the right adrenal gland. A CAT scan identified this mass as an adrenal hemorrhage.


METHODS
Anticoagulation treatment was discontinued because the bleeding and thrombocytopenia and the patient's pain subsided. A few days later, he experienced similar pain, this time radiating to the left side. A second hematoma was discovered in the left adrenal gland. The patient developed symptoms of acute adrenal insufficiency, which subsided after therapy. The bilateral adrenal hemorrhage was considered to be secondary bleeding following thromboses in the venous system of the adrenal gland. The thromboses were due to the underlying APS. Anticoagulation therapy was resumed, and the patient's condition stabilised without further complications.


CONCLUSIONS
The cessation of anticoagulation therapy in this patient paradoxically led to hemorrhage, this time of the contralateral adrenal gland. Unilateral and, especially, bilateral adrenal bleeding should give rise to the suspicion of thrombophilic disorders such as APS or heparin-induced thrombocytopenia (HIT); for which careful anticoagulation is the treatment of choice.
Medizinische Abteilung, Kreisklinik München-Perlach, München. s2a@kkh-perlach.de
T
T
Heller
M
M
Bergholtz
F
F
Martin
V
V
Borck
D015746:Abdominal Pain / Q000209:etiology; D000303:Adrenal Cortex Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D000311:Adrenal Glands / Q000000981:diagnostic imaging; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000150:complications*; D001327:Autoimmune Diseases / Q000139:chemically induced / Q000150:complications; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D013921:Thrombocytopenia / Q000139:chemically induced / Q000150:complications; D014463:Ultrasonography
D000925:Anticoagulants; D006493:Heparin