title: Acute adrenal insufficiency due to primary antiphospholipid antibody syndrome.
abstract: BACKGROUND
  We report a case of acute adrenal insufficiency (AAI) in a patient with antiphospholipid syndrome (APS).
  
  
  METHODS
  A 44-year-old female patient presented to us with acute abdominal pain associated with recurrent vomiting and giddiness. On examination, her blood pressure was 80/50 mm Hg. Systemic examination was normal. Further evaluation revealed hypocortisolemia with elevated plasma adrenocorticotropin hormone indicative of primary adrenal insufficiency. Her abdominal computed tomography scan showed features of evolving bilateral adrenal infarction. Etiological work-up revealed prolonged activated thromboplastin time, which didn't correct with normal plasma, her anti-cardiolipin antibody and lupus anticoagulant were also positive. She was diagnosed to have APS with adrenal insufficiency and she was started on intravenous steroids and heparin infusion.
  
  
  CONCLUSIONS
  AAI due to the APS can present with acute abdominal pain followed by hypotension. A high index of suspicion is needed to make the correct diagnosis and to initiate appropriate treatment.
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Kishore Kumar
authors.initials: KK
authors.lastname: Behera
authors.forename: Nitin
authors.initials: N
authors.lastname: Kapoor
authors.forename: M S
authors.initials: MS
authors.lastname: Seshadri
authors.forename: Simon
authors.initials: S
authors.lastname: Rajaratnam
keywords: Addison's disease; Adrenal; primary antiphospholipid antibody syndrome