title: Adrenal crisis due to bilateral adrenal hemorrhage in primary antiphospholipid syndrome.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Usanee
authors.initials: U
authors.lastname: Ringkananon
authors.forename: Weerapan
authors.initials: W
authors.lastname: Khovidhunkit
authors.forename: Varaphon
authors.initials: V
authors.lastname: Vongthavaravat
authors.forename: Vitaya
authors.initials: V
authors.lastname: Sridama
authors.forename: Siripon
authors.initials: S
authors.lastname: Lalitanantpong
authors.forename: Thiti
authors.initials: T
authors.lastname: Snabboon
mesh_terms: 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