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Adrenal crisis due to bilateral adrenal hemorrhage in primary antiphospholipid syndrome

Usanee Ringkananon1, Weerapan Khovidhunkit, Varaphon Vongthavaravat

  • 1Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Journal of the Medical Association of Thailand = Chotmaihet Thangphaet
|September 9, 2005
PubMed

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.

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