title: Abdominal pain and severe hyponatremia after lung cancer surgery.
abstract: We report a 54-year-old man who presented with abdominal pain and severe hyponatremia a few days after a left lower lobectomy for lung cancer. An abdominal computed tomography scan without contrast showed a bilateral adrenal hemorrhagic infarction, mainly on the right side. Serum sodium level was 113 mmol/L, and cortisol level was 0 microg/L. Anticardiolipin-type antibodies (immunoglobulin G isotype) level was 75 GPL/mL (normal value < 10). With hydrocortisone supplementation and curative doses of low-molecular-weight heparin, the patient recovered progressively and was discharged on postoperative day 17. Final diagnosis was bilateral adrenal gland hemorrhagic necrosis leading to adrenal insufficiency, associated with antiphospholipid syndrome. We discuss the mechanism and the role of the operation in the occurrence of this particularly rare and potentially life-threatening complication. Recommendations to prevent thrombosis in surgical patients who have antiphospholipid antibodies are lacking.
authors.affiliation: Département Thoracique, Institut Mutualiste Montsouris, Paris, France. baptiste.stern@imm.fr
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Stern
authors.forename: Julie
authors.initials: J
authors.lastname: Cosserat
authors.forename: Christiane
authors.initials: C
authors.lastname: Strauss
authors.forename: Philippe
authors.initials: P
authors.lastname: Girard
authors.forename: Dominique
authors.initials: D
authors.lastname: Gossot
authors.forename: Rafaelle
authors.initials: R
authors.lastname: Caliandro
authors.forename: Pierre
authors.initials: P
authors.lastname: Magdeleinat
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000307:Adrenal Gland Diseases / Q000209:etiology / Q000473:pathology; D000311:Adrenal Glands / Q000098:blood supply; D000309:Adrenal Insufficiency / Q000209:etiology*; D016736:Antiphospholipid Syndrome / Q000150:complications*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000601:surgery*; D006801:Humans; D007010:Hyponatremia / Q000209:etiology; D007238:Infarction; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications