Adrenal insufficiency complicated with antiphospholipid syndrome (APS)

Area of Science:

• Endocrinology
• Hematology
• Rheumatology

Background:

• Antiphospholipid syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis and pregnancy complications.
• Adrenal insufficiency is a condition where the adrenal glands do not produce enough steroid hormones.

Observation:

• A 69-year-old woman presented with nausea, vomiting, hyponatremia, and hypoglycemia.
• Imaging revealed bilateral adrenal enlargement, and further tests showed high ACTH, low cortisol, thrombocytopenia, and positive antiphospholipid antibodies (anti-cardiolipin IgG, anti-beta2GPI, lupus anticoagulants).

Findings:

• The patient was diagnosed with APS complicated by adrenal insufficiency secondary to hemorrhagic infarction of the adrenal glands.
• Treatment with corticosteroids, low-dose aspirin, and fluid resuscitation led to rapid clinical improvement, normalization of platelet counts, and activated partial thromboplastin time (aPTT).

Implications:

• This case underscores the importance of considering APS in patients presenting with adrenal insufficiency, particularly when accompanied by thrombotic events.
• It is the second reported case in Japan of APS complicated with bilateral adrenal hemorrhage, emphasizing the need for increased awareness of this rare but serious complication.