Endocrine Abstracts

Introduction: Bilateral adrenal haemorrhage is a rare potentially life-threatening event that occurs either in traumatic or non traumatic conditions. We present a rare case report of bilateral adrenal haemorrhage due to anti-phospholipid antibody syndrome.

Case report: A 54 year old Iranian origin male presented with abdominal pain and collapse. His past history includes unprovoked DVT 6 months ago and off the warfarin recently. CT abdomen showed bilateral Adrenal haemorrhage. Early morning cortisol was 54. He was subsequently treated with i.v. hydrocortisone, antibiotics, fluids and made a good recovery. He had further admission within 1 week of discharge with chest pain and hypotension due to acute myocardial infarction. Coronary artery angiogram was normal. Further investigation showed positive ANA and lupus anticoagulant positive. He was discharged on oral hydrocortisone and warfarin. The diagnosis of anti phospholipid antibody syndrome was confirmed after repeat lupus anticoagulant positive at 3 months with satisfactory clinical and biochemical criteria.

Discussion and conclusion: Acute adrenal insufficiency due to bilateral adrenal haemorrhage is a rare manifestation of APS. Prompt treatment with steroids needed to achieve favourable outcome.