EVOLVING ADRENAL DYSFUNCTION AFTER BILATERAL ADRENAL INFARCTION: A CASE REPORT.

Area of Science:

• Endocrinology
• Vascular Medicine
• Autoimmune Diseases

Background:

• Antiphospholipid syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis.
• Adrenal complications, including infarction, are recognized but uncommon manifestations of APS.
• Understanding the spectrum of adrenal dysfunction in APS is crucial for timely diagnosis and management.

Observation:

• A 50-year-old male with APS presented with severe abdominal pain, leading to the identification of sequential bilateral adrenal infarction.
• Initial imaging revealed left adrenal infarction, followed by hemorrhagic conversion and new right adrenal infarction.
• The patient exhibited evolving adrenal insufficiency, initially presenting with glucocorticoid deficiency and later developing mineralocorticoid deficiency.

Findings:

• Contrast-enhanced CT imaging demonstrated sequential bilateral adrenal infarction and hemorrhage.
• Cosyntropin stimulation tests confirmed primary glucocorticoid insufficiency and, upon follow-up, also revealed aldosterone deficiency.
• Laboratory findings and imaging correlated with the development of hyponatremia, hypotension, and normokalemia.

Implications:

• Bilateral adrenal infarction is the most common endocrine complication of APS.
• Imaging findings of adrenal infarction do not reliably predict the pattern or severity of subsequent adrenal dysfunction.
• Comprehensive endocrine evaluation, including assessment for glucocorticoid, mineralocorticoid, and androgen deficiencies, is essential at the time of diagnosis and during follow-up for patients with APS and adrenal infarction.