title: Adrenal insufficiency complicated with antiphospholipid syndrome (APS).
abstract: We describe a 69-year-old woman with bilateral adrenal hemorrhage complicated with antiphospholipid syndrome (APS). She was hospitalized with nausea and vomiting in September 2003. Laboratory data demonstrated hyponatremia, hypoglycemia and prolongation of activated partial thromboplastin time (aPTT). Abdominal computed tomography showed bilateral adrenal enlargement. In October 2003, she demonstrated altered mental status with progressive hyponatremia, a high level of ACTH, and a low level of serum cortisol. She also showed thrombocytopenia, anti-cardiolipin IgG antibody, anti-beta2GPI antibody, and lupus anticoagulants. After four months, anti-cardiolipin IgG antibody was still positive. Based on these findings, she was diagnosed as having APS complicated with adrenal insufficiency due to hemorrhagic infarction. After treatment with corticosteroid, a low dose of aspirin and normal saline infusion, her condition quickly improved. Platelet counts and aPTT were also normalized. To our knowledge, this is the second Japanese case of APS complicated with bilateral adrenal hemorrhage. APS should be considered an important underlying cause of adrenal insufficiency.
authors.affiliation: Third Department of Internal Medicine, Akita University School of Medicine.
authors.forename: Naohito
authors.initials: N
authors.lastname: Fujishima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Komatsuda
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ohyagi
authors.forename: Masumi
authors.initials: M
authors.lastname: Fujishima
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Tada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohtani
authors.forename: Hideki
authors.initials: H
authors.lastname: Wakui
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirokawa
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Sawada
mesh_terms: D000307:Adrenal Gland Diseases / Q000150:complications / Q000208:ethnology / Q000209:etiology*; D000311:Adrenal Glands / Q000098:blood supply*; D000309:Adrenal Insufficiency / Q000000981:diagnostic imaging / Q000208:ethnology / Q000209:etiology*; D000368:Aged; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000208:ethnology; D044466:Asian People; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000208:ethnology / Q000209:etiology*; D006801:Humans; D007238:Infarction / Q000209:etiology*; D014057:Tomography, X-Ray Computed