Antiphospholipid syndrome and adrenal insufficiency: a case-report

Abstract

Antiphospholipid syndrome (APS) is a thrombophilia disorder that
may be diagnosed alone or associated with a systemic disease.
A 58 years-old male patient diagnosed with primary APS,
presented with asthenia, vomiting and diffuse abdominal pain.
He was obtunded with hypotension, tachycardia and fever. The
following values were found: Platelets 76000/mm3, gamma-glutamyl transpeptidase 168IU/L, alkaline phosphatase 197IU/L
and gallstones were identified on abdominal ultrasound. Despite
antibiotics and an increase adrenergic support the patient got
worse. The adrenocorticotropic hormone was increased, cortisol
decreased and the abdominal CT scan showed multiple hematic
nodules in the adrenal glands. Adrenal insufficiency associated
with primary APS was diagnosed and corticosteroid begun with
excellent response. Two years later antinuclear antibodies and
anti-ds DNA were found and the diagnosis of systemic lupus
erythematosus and secondary APS was reached.
This case-report highlights the involvement of adrenal glands
by APS and the ongoing unpredictability of autoimmune diseases.