© 1992 British Society for Rheumatology
case-report |
BILATERAL ADRENAL INFARCTION, HYPOADRENALISM AND SPLINTER HAEMORRHAGES IN THE ‘PRIMARY’ ANTIPHOSPHOLIPID SYNDROME
*Department of Rheumatology, St Thomas' Hospital London, SE1 7EH
Department of Radiology, St Thomas' Hospital London, SE1 7EH
Department of Endocrinology, The West Middlesex Hospital London
Correspondence to:
Correspondence to Dr R. Asherson, Director of Clinical Research & Honorary Consultant Physician, The Lupus/Arthritis Research Unit, The Rayne Institute, St Thomas' Hospital, London, SE1 7EH
We describe a patient with a 3-year history of recurrent deep vein thromboses (DVT) of the lower limbs, who developed adrenal insufficiency following withdrawal of warfarin therapy. Multiple splinter haemorrhages of the nail beds were evident, simultaneous with the development of adrenal infarction in the absence of infective endocarditis. CT scans of the adrenal glands were consistent with bilateral adrenal infarctions. The patient had persistently high titres of IgG anticardiolipin antibodies (aCL) over the previous 4 years in the absence of antinuclear antibodies (ANA), antibodies to double stranded deoxyribonucleic acid (dsDNA) or extractable nuclear antigens (ENA). Thrombocytopenia and an intermittently positive Coombs' test had been noted. Previous episodes of DVT were associated with inadequate warfarin control and a period of warfarin resistance. He conforms to a diagnosis of a primary antiphospholipid syndrome.
KEY WORDS: Hypoadrenalism, Antiphospholipid antibodies
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