Definitive bilateral adrenal failure in antiphospholipid syndrome

Antiphospholipid antibodies may signal the formation of vascular thrombi in the Antiphospholipid syndrome (APS). A rare complication of APS is adrenal insufficiency resulting from venous thrombus followed by hemorrhagic infarction. We describe the case of a 42-year-old male with APS presenting with vomiting and abdominal pain. Through laboratory and imaging diagnostic exams, we confirmed the diagnosis of bilateral adrenal hemorrhage and subsequent adrenal failure. We also conducted a search of literature associating bilateral adrenal thrombosis to APS, and describe the two pathological mechanisms most often cited to explain this phenomenon. To our knowledge, this is the first Portuguese case of adrenal insufficiency due to APS-associated bilateral adrenal hemorrhage.