Spontaneous Adrenal Hemorrhage with Mild Hypoadrenalism in a Patient Anticoagulated with Apixaban for Antiphospholipid Syndrome: A Case Report and Literature Review

Tan, Jia Wei; Shukla, Anant; Hu, Jiun-Ruey; Majumdar, Sachin

doi:10.1155/2022/6538800

Cited by 4 publications

(7 citation statements)

References 22 publications

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“…Hemorrhage is the leading cause of AI in APS, followed by infarction [1]. Adrenal involvement is often bilateral [3]. The vascular system of the adrenal gland is unique and complex [3].…”

Section: Discussionmentioning

confidence: 99%

“…Adrenal involvement is often bilateral [3]. The vascular system of the adrenal gland is unique and complex [3].…”

Section: Discussionmentioning

confidence: 99%

“…The transition from the artery to the capillary plexus is referred to as the "vascular dam," which is drained by the medullary sinusoids and eventually forms a single central adrenal vein. Venous stasis and hypercoagulability in this region can promote thrombosis, infarction, and subsequent hemorrhage [3].…”

Section: Discussionmentioning

confidence: 99%

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

Iijima

Ishikawa

Motono

et al. 2023

Preprint

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Background Antiphospholipid syndrome causes systemic arterial and venous thromboses owing to the presence of antiphospholipid antibodies. Adrenal insufficiency is a rare complication of antiphospholipid syndrome. If left untreated, adrenal insufficiency may result in fatal outcomes. Case presentation: A 64-year-old man underwent surgery for a left traumatic hemothorax. He concurrently had antiphospholipid syndrome and was receiving warfarin. Postoperatively, he complained of severe lumbar back pain, despite resuming anticoagulation therapy. He developed 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 revealed high-intensity areas in the bilateral adrenal glands. The cortisol and adrenocorticotropic hormone levels were 3.30 µg/dL and 185.1 pg/dL, respectively. The patient was diagnosed with bilateral adrenal infarction and acute adrenal insufficiency. Hydrocortisone was immediately administered. Adrenal insufficiency improved gradually. The patient was discharged after initiating steroid replacement therapy. Conclusions The timing of postoperative anticoagulant therapy initiation is controversial. AI due to adrenal infarction should be monitored while anticoagulant therapy is discontinued in patients with APS.

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“…Hemorrhage is the leading cause of AI in APS, followed by infarction [1]. Adrenal involvement is often bilateral [3]. The vascular system of the adrenal gland is unique and complex [3].…”

Section: Discussionmentioning

confidence: 99%

“…Adrenal involvement is often bilateral [3]. The vascular system of the adrenal gland is unique and complex [3].…”

Section: Discussionmentioning

confidence: 99%

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

Iijima

Ishikawa

Motono

et al. 2023

Preprint

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“… 118 A 45-year-old male was confirmed with bilateral adrenal hemorrhage while being treated with apixaban in addition to a newly detected anti-phospholipid syndrome. 119 Another adult female was reported with bilateral adrenal infarction due to COVID-19 infection; she was known to have autoimmune hepatitis and anti-phospholipid syndrome, as well. 120 Interestingly, 3 more cases of the severe condition were reported due to motor vehicle accidents.…”

Section: Discussionmentioning

confidence: 99%

Addison’s Disease: Diagnosis and Management Strategies

Cârșote¹,

Nistor²

2023

IJGM

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We aim to overview Addison’s disease (AD) with regard to current diagnosis and management. This is a narrative review of full-length articles published in English between January 2022 and December 2022 (including online ahead of print versions) in PubMed-indexed journals. We included original studies in living humans regardless of the level of statistical significance starting from the key search terms “Addison’s disease” or “primary adrenal insufficiency” in title or abstract. We excluded articles with secondary adrenal insufficiency. Briefly, 199 and 355 papers, respectively were identified; we manually checked each of them, excluded the duplicates, and then selected 129 based on their clinical relevance in order to address our 1-year analysis. We organized the data in different subsections covering all published aspects on the subject of AD. To our knowledge, this is the largest AD retrospective from 2022 on published data. A massive role of genetic diagnosis especially in pediatric cases is highlighted; the importance of both pediatric and adult awareness remains since unusual presentations continue to be described. COVID-19 infection is a strong player amid this third year of pandemic although we still not do have large cohorts in this particular matter as seen, for instance, in thyroid anomalies. In our opinion, the most important topic for research is immune checkpoint inhibitors, which cause a large panel of endocrine side effects, AD being one of them.

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“…Bleeding is the leading cause of AI in APS, followed by infarction [ 1 ]. Adrenal involvement is usually bilateral [ 3 ], and the vascular system of the adrenal gland is unique and complex [ 3 ]. Capillary branches from three main arteries form a vascular plexus around the zona reticularis.…”

Section: Discussionmentioning

confidence: 99%

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

Iijima,

Ishikawa,

Motono

et al. 2023

Int J Emerg Med

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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.

show abstract

Spontaneous Adrenal Hemorrhage with Mild Hypoadrenalism in a Patient Anticoagulated with Apixaban for Antiphospholipid Syndrome: A Case Report and Literature Review

Cited by 4 publications

References 22 publications

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

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

Addison’s Disease: Diagnosis and Management Strategies

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

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