Adrenal crisis due to bilateral adrenal hemorrhage in primary antiphospholipid syndrome.
The authors report a case of a 56-year-old Thai woman with a history of recurrent venous thrombosis, spontaneous abortion and Graves' disease who presented with bilateral flank pain, nausea, vomiting and low-grade fever followed by hypotension. Adrenal crisis from bilateral adrenal hemorrhage was diagnosed by a low serum cortisol level during hypotension and bilateral hyperdense oval masses in each of the adrenal glands in a computerized tomographic study. Her hemostatic and serologic profile was compatible with primary antiphospholipid syndrome. Rapid improvement was observed after the administration of intravenous hydrocortisone. She was discharged on long-term glucocorticoid replacement for her primary adrenal insufficiency as well as an anticoagulant for prevention of thrombosis. The antiphospholipid syndrome should be suspected in a patient presenting with adrenal crisis without a distinct etiology.
Ringkananon
Usanee
U
Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Khovidhunkit
Weerapan
W
Vongthavaravat
Varaphon
V
Sridama
Vitaya
V
Lalitanantpong
Siripon
S
Snabboon
Thiti
T
D000311:Adrenal Glands / Q000473:pathology; D000309:Adrenal Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D016736:Antiphospholipid Syndrome / Q000150:complications*; D005260:Female; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D014057:Tomography, X-Ray Computed