Bilateral adrenal infarction and insufficiency associated with antiphospholipid syndrome and surgery: a case report

Abstract

Background Antiphospholipid syndrome causes systemic arterial and venous thromboses due to the presence of antiphospholipid antibodies. Adrenal insufficiency is a rare complication of antiphospholipid syndrome that may result in fatal outcomes if left untreated. Therefore, we report adrenal insufficiency as a rare complication of bilateral adrenal infarction associated with antiphospholipid syndrome and trauma surgery. Case presentation A 64-year-old male patient underwent surgery for a left traumatic hemothorax. He concurrently had antiphospholipid syndrome and was receiving warfarin. Postoperatively, the patient complained of severe lumbar back pain despite resuming anticoagulation therapy, and he experienced paralytic ileus and shock. Abdominal contrast-enhanced computed tomography revealed adrenal swelling and increased surrounding retroperitoneal adipose tissue density. Diffusion-weighted abdominal magnetic resonance imaging showed high-intensity areas in the bilateral adrenal glands. Cortisol and adrenocorticotropic hormone levels were 3.30 μg/dL and 185.1 pg/dL, respectively. Subsequently, the patient was diagnosed with bilateral adrenal infarction and acute adrenal insufficiency, and hydrocortisone was immediately administered. Adrenal insufficiency improved gradually, and the patient was discharged after initiating steroid replacement therapy. Conclusions The timing of postoperative anticoagulant therapy initiation remains controversial. Therefore, adrenal insufficiency due to adrenal infarction should be monitored while anticoagulant therapy is discontinued in patients with antiphospholipid syndrome.

Acute spontaneous non-hemorrhagic adrenal infarction with systemic lupus erythematosus and antiphospholipid antibody syndrome: A case report

“…In addition, the lesion was also high-intensity on diffusion-weighted image due to restricted diffusion water molecules. [ 6 ]…”

“…On contrast CT/magnetic resonance imaging, the non-hemorrhagic AI had obviously poor or no enhancement. [ 6 ] Moschetta et al had found the “capsular sign,” with 100% specificity, in diagnosis of acute adrenal ischemia. [ 18 ] And the “capsular sign” is likely resulting from the residual blood supply of the adrenal capsular veins.…”

“…Acute adrenal infarction (AI) is very rare and easily overlooked, especially in patients without adrenal insufficiency, which is diagnosed mainly by imaging. AI was relatively common in antiphospholipid antibody syndrome (APS), [ 3 – 6 ] pregnancy, [ 7 ] and also existed in Crohn disease, [ 8 ] COVID-19, [ 9 ] myelodysplastic/myeloproliferative neoplasm, [ 10 ] substance use (e.g., methamphetamine), [ 11 ] heparininduced thrombocytopenia [ 12 ] and aortic dissection, [ 2 ] etc. However a large portion of individuals originally manifested signs of AI before the primary disease was identified.…”

Glucocorticoids in lung cancer: Navigating the balance between immunosuppression and therapeutic efficacy

“…Endogenously produced GCs provide basal anti-inflammatory effects, with an escalated secretion in response to inflammatory challenges [ 131 ]. Hence, animals and humans with adrenal insufficiency demonstrate amplified responses to minor injuries post-adrenalectomy [ 132 , 133 ]. This observation has prompted speculation regarding the potential role of insufficient GC secretion in response to trauma or infection in the pathogenesis of select chronic inflammatory disorders [ 134 , 135 ].…”