primary adrenal insufficiency due to bilateral adrenal hemorrhage in a patient with antiphospholipid syndrome

1. Abstract We describe a case of primary adrenal insufficiency due to bilateral adrenal hemorrhage in a patient with Antiphospholipid Syndrome (APS). A 69-year-old male presented with 2-3-month history of unintentional weight loss, weakness and postural dizziness. Investigations revealed low morning cortisol, high ACTH and inadequate response to cosyntropin stimulation test. Additional laboratory testing showed prolonged APTT. He had an established diagnosis of APS and was on anticoagulation. CT abdomen and pelvis demonstrated bilateral enlargement of the adrenal glands. Patient was treated with steroids for adrenal insufficiency secondary to APS. His symptoms improved with steroids and repeat CT scan showed significant decrease in the size of adrenal glands at 3 months and normalization by 8 months. Primary adrenal insufficiency from APS is caused by either spontaneous hemorrhagic infarction or necrosis due to adrenal vein thrombosis. Although recovery of adrenal function is considered irreversible, warranting lifelong therapy with steroids, however, some cases of recovery in the setting of adrenal hemorrhage have been reported.