Primary Adrenal Failure due to Antiphospholipid Syndrome.

Murat Sahin,Serife Nur Boysan,Hatice Sahin,Dilek Tuzun,Kamile Gul,Bülent Mese,Ayten Oguz

doi:10.1155/2015/161497

Murat Sahin, Serife Nur Boysan + Show 5 more

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https://doi.org/10.1155/2015/161497

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Abstract

Background. Antiphospholipid syndrome (APS) characterized by thrombosis and abortus may rarely cause primary adrenal failure. Case Presentations. A 34-year-old male presented with hypotension, hypoglycemia, hyperpigmentation on his skin and oral mucosa, scars on both legs, and loss of consciousness. In laboratory examinations, hyponatremia (135 mmol/L), hyperpotassemia (6 mmol/L), and thrombocytopenia (83 K/µL) were determined. Cortisol (1.91 µg/dL) and adrenocorticotropic (550 pg/mL) hormone levels were also evaluated. The patient was hospitalized with a diagnosis of acute adrenal crisis due to primary adrenal insufficiency. A Doppler ultrasound revealed venous thrombosis. The patient was diagnosed with antiphospholipid syndrome after the detection of venous thrombosis, thrombocytopenia, elevated aPTT, and anticardiolipin antibody levels. Anticoagulation treatment was started for antiphospholipid syndrome. The patient is now following up with hydrocortisone, fludrocortisone, and warfarin sodium. Conclusion. Antiphospholipid syndrome is a rare reason for adrenal failure. Antiphospholipid syndrome should be suspected if patients have morbidity secondary to venous-arterial thrombosis.

Highlights

Primary adrenal failure (PAF) is insufficiency of both mineralocorticoid and glucocorticoid production in the adrenal cortex
Antiphospholipid syndrome (APS) may occur as an isolated disorder or it may be related to another autoimmune disease
The most common cause of primary adrenal failure is the autoimmune destruction of the adrenal glands but infections, metastatic cancers, adrenal hemorrhage, infarct, and medications may cause primary adrenal failure as well

Summary

Background

Antiphospholipid syndrome (APS) characterized by thrombosis and abortus may rarely cause primary adrenal failure. A 34-year-old male presented with hypotension, hypoglycemia, hyperpigmentation on his skin and oral mucosa, scars on both legs, and loss of consciousness. Cortisol (1.91 μg/dL) and adrenocorticotropic (550 pg/mL) hormone levels were evaluated. The patient was hospitalized with a diagnosis of acute adrenal crisis due to primary adrenal insufficiency. The patient was diagnosed with antiphospholipid syndrome after the detection of venous thrombosis, thrombocytopenia, elevated aPTT, and anticardiolipin antibody levels. Anticoagulation treatment was started for antiphospholipid syndrome. The patient is following up with hydrocortisone, fludrocortisone, and warfarin sodium. Antiphospholipid syndrome is a rare reason for adrenal failure. Antiphospholipid syndrome should be suspected if patients have morbidity secondary to venous-arterial thrombosis

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