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Acute adrenal failure as the heralding symptom of primary antiphospholipid syndrome: report of a case and review of the literature

Third Division of Internal Medicine and ¹ Division of Endocrinology, Department of Medical and Surgical Sciences, University of Padua School of Medicine, I-35128, Padua, Italy

(Correspondence should be addressed to F Presotto, Department of Medical and Surgical Sciences, Third Division of Internal Medicine, University of Padua Medical School, via Giustiniani 2, I-35128 Padua, Italy; Email: fabio.presotto{at}unipd.it)

Abstract

Acute adrenal failure is a potentially fatal condition if overlooked. Occasionally, acute adrenal insufficiency may ensue from bilateral adrenal haemorrhage in patients with known antiphospholipid syndrome (APS). APS is characterized by recurrent arterial and venous thrombosis, pregnancy complications and detection of autoantibodies to phospholipids. This syndrome may be associated with non-organ specific diseases (e.g. connective tissue disorders) or with malignancies, but it may also appear in isolated form (primary APS). In a very few cases the heralding manifestation is given by adrenal failure. We report here a 63-year-old man presenting with acute adrenal insufficiency as the opening clinical manifestation of an APS. We also carried out a computer-aided search of the literature to identify all cases of primary adrenal failure as the first-recognized expression of a primary APS, a condition that not so infrequently may be tackled by endocrinologists. 20 patients fulfilled the inclusion criteria. The great majority of them were males (75%) with a mean age of 42 years. Abdominal pain was present in 14 patients, followed by fever (13 patients) and hypotension (12 patients). The main morphological findings by computed tomography or magnetic resonance were consistent with bilateral adrenal haemorrhage in 11 patients. Lupus anticoagulant was present in all of the 19 tested patients. Our observations emphasize the importance in the assessment of clotting times, and possibly of antiphospholipid antibodies, in all patients with diagnosis of rapidly progressive adrenal failure and concurrent abdominal pain.

This article has been cited by other articles:

				I Uthman, I Salti, and M Khamashta Endocrinologic Manifestations of the Antiphospholipid Syndrome Lupus, August 1, 2006; 15(8): 485 - 489. [Abstract] [PDF]