Antiphospholipid syndrome and adrenal insufficiency: a case series

Whyte, MB, Grove, G, Carroll, P and Powrie, J (2012) Antiphospholipid syndrome and adrenal insufficiency: a case series In: Society for Endocrinology BES 2012, 2012-03-18 - 2012-03-22, Harrogate, UK.

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Abstract

Introduction: Antiphospholipid syndrome (APS) is the association of anti-cardiolipin antibodies and venous &amp; arterial thrombosis. APS accounts for <0.5% of cases of hypoadrenalism. We present a series of 5 such cases occurring at our institution plus a further patient identified with unilateral adrenal haemorrhage. Case 1 presented with nausea, vomiting and weight loss. Lupus anticoagulant positive. Commenced aspirin 300 mg. 6-weeks later represented with dehydration, confusion and hyperpigmented skin. Abdominal CT showed bilateral adrenal infarction. Adrenal antibody negative. Peak cortisol 213nmol/L on short synacthen test (SST). Cases 2&amp;3 were known APS but later developed adrenal insufficiency peri-partum. In Case 2, this occurred 3-years following unilateral adrenal haemorrhage. At 6 weeks gestation, warfarin was switched to clexane. 1-week later she developed hydronephrosis and sepsis. CT showed enlarged contralateral adrenal. Over subsequent days ACTH rose to 147 ng/L. Case 3 received clexane during pregnancy. At 30 weeks she underwent urgent caesarean section which was complicated by postoperative wound infection and sepsis. ACTH 321 ng/L. Adrenal infarction on CT abdomen. Cases 4&amp;5 also had pre-existing APS. Case 4 developed GI bleeding on warfarin - corrected with vitamin K and fresh frozen plasma. Subsequently developed femoral DVT, splinter haemorrhages, fever and raised ESR. CT showed bilateral adrenal enlargement. ACTH 321 ng/L, peak cortisol 95 nmol/L on SST. Case 5 acutely developed diarrhoea &amp; vomiting with INR >10 and Hb 4.9 g/dL. Pelvic haematoma on admission CT. Subsequently became septic &amp; hypotensive. Repeat CT showed adrenal haemorrhage. ACTH 290 ng/L, cortisol <30 nmol/L. Case 6 has APS and an adrenal incidentaloma that developed haemorrhagic features 1-year after warfarin therapy. Glucocorticoid production is currently preserved. Conclusion: Acute events such as sepsis or pregnancy can precipitate adrenal failure in patients with APS by venous infarction with or without intraglandular haemorrhage. The presence of unilateral adrenal infarction/haemorrhage may leave a patient vulnerable to later hypoadrenalism.

Item Type:	Conference or Workshop Item (Conference Poster)
Subjects :	Nutrition
Divisions :	Faculty of Health and Medical Sciences > School of Biosciences and Medicine > Department of Nutritional Sciences
Authors :	Name Email ORCID Whyte, MB Grove, G Carroll, P Powrie, J
Date :	18 March 2012
Copyright Disclaimer :	©2012 BioScientifica
Depositing User :	Symplectic Elements
Date Deposited :	20 Oct 2016 13:22
Last Modified :	31 Oct 2017 18:49
URI:	http://epubs.surrey.ac.uk/id/eprint/812530

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