Adrenal hemorrhage associated with antiphospholipid antibody syndrome

Gyi P. Mo, MD, Pauline Germaine, DO, Jason Mastoris, AB, and David H. Henry, MD

Pennsylvania Hospital, Philadelphia, PA

Adrenal hemorrhage due to antiphospholipid antibody syndrome is rare and has been associated with adrenal insufficiency in the majority of published cases. The patient described in this report had long-standing, severe antiphospholipid antibody syndrome with a strong propensity to venous and arterial thromboses and other clotting events, requiring chronic warfarin and aspirin anticoagulation. Only a few days after stopping his warfarin therapy in preparation for a tooth extraction, he experienced adrenal gland infarction and hemorrhage on the right side. This patient was fortunate enough to bleed unilaterally and, despite a finding of borderline subnormal random serum cortisol levels and a suboptimal cosyntropin stimulation test result, did not require steroid replacement therapy. Following hospitalization and reinstitution of his anticoagulation regimen, the patient recovered and, 6 months later, has remained symptom free with stable clinical and laboratory findings. Patients with antiphospholipid antibodies who present with vague -abdominal or flank pain should be suspected of having adrenal infarction or hemorrhage as part of their evaluation.

Commun Oncol 2005;2:265–269 print e-mail full text 200 kb