[Adrenal insufficiency and antiphospholipid syndrome]

We report a case of acute adrenal insufficiency secondary to bilateral adrenal hemorrhage, in a 53 year old patient, occurring in the post-operative course of a lower limb ischemia. The patient was found to have a lupus anticoagulant, and it was concluded that the adrenal insufficiency was related to a primary antiphospholipid syndrome (PAPS). The PAPS is a cause of both, acute and chronic adrenal insufficiency. Endocrinologists are relatively little familiar with this etiology. Pathophysiologically, thrombosis and bilateral adrenal hemorrhage can result in progressive bilateral adrenal atrophy, requiring life long substitution. Therefore, the importance to search for antiphospholipid antibodies in the evaluation of acute and chronic adrenal insufficiency has to be emphasized.