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Adrenal Crisis Due To Bilateral Adrenal Hemorrhage in Primary Antiphospholipid Syndrome


Usanee Ringkananon, MD*, Weerapan Khovidhunkit, MD, PhD*,
Varaphon Vongthavaravat, MD*, Vitaya Sridama, MD*,
Siripon Lalitanantpong, MD**, Thiti Snabboon, MD*

* Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University
** Department of Radiology, Faculty of Medicine, Chulalongkorn University


The authors report a case of a 56-year-old Thai woman with a history of recurrent venous thrombosis, spontaneous abortion and Gravesí disease who presented with bilateral flank pain, nausea, vomiting and low-grade fever followed by hypotension. Adrenal crisis from bilateral adrenal hemorrhage was diagnosed by a low serum cortisol level during hypotension and bilateral hyperdense oval masses in each of the adrenal glands in a computerized tomographic study. Her hemostatic and serologic profile was compatible with primary antiphospholipid syndrome. Rapid improvement was observed after the administration of intravenous hydrocortisone. She was discharged on long-term glucocorticoid replacement for her primary adrenal insufficiency as well as an anticoagulant for prevention of thrombosis. The antiphospholipid syndrome should be suspected in a patient presenting with adrenal crisis without a distinct etiology.

Keyword : Antiphospholipid syndrome, Adrenal hemorrhage and adrenal crisis

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