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Addison’s disease in antiphospholipid syndrome: a rare complication

Addison’s disease (AD) is the most common endocrine manifestation of antiphospholipid syndrome (APS), but it remains a very rare complication of the syndrome. It is caused by adrenal venous thrombosis and consequent hemorrhagic infarction or by spontaneous (without thrombosis) adrenal hemorrhage, us...

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Autores principales: Oliveira, Diana, Ventura, Mara, Melo, Miguel, Paiva, Sandra, Carrilho, Francisco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280132/
https://www.ncbi.nlm.nih.gov/pubmed/30481151
http://dx.doi.org/10.1530/EDM-18-0118
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author Oliveira, Diana
Ventura, Mara
Melo, Miguel
Paiva, Sandra
Carrilho, Francisco
author_facet Oliveira, Diana
Ventura, Mara
Melo, Miguel
Paiva, Sandra
Carrilho, Francisco
author_sort Oliveira, Diana
collection PubMed
description Addison’s disease (AD) is the most common endocrine manifestation of antiphospholipid syndrome (APS), but it remains a very rare complication of the syndrome. It is caused by adrenal venous thrombosis and consequent hemorrhagic infarction or by spontaneous (without thrombosis) adrenal hemorrhage, usually occurring after surgery or anticoagulant therapy. We present a clinical case of a 36-year-old female patient with a previous diagnosis of APS. She presented with multiple thrombotic events, including spontaneous abortions. During evaluation by the third episode of abortion, a CT imaging revealed an adrenal hematoma, but the patient was discharged without further investigation. A few weeks later, she presented in the emergency department with manifestations suggestive of adrenal insufficiency. Based on that assumption, she started therapy with glucocorticoids, with significant clinical improvement. After stabilization, additional investigation confirmed AD and excluded other etiologies; she also started mineralocorticoid replacement. This case illustrates a rare complication of APS that, if misdiagnosed, may be life threatening. A high index of suspicion is necessary for its diagnosis, and prompt treatment is crucial to reduce the morbidity and mortality potentially associated. LEARNING POINTS: AD is a rare but life-threatening complication of APS. It is important to look for AD in patients with APS and a suggestive clinical scenario. APS must be excluded in patients with primary adrenal insufficiency and adrenal imaging revealing thrombosis/hemorrhage. Glucocorticoid therapy should be promptly initiated when AD is suspected. Mineralocorticoid replacement must be started when there is confirmed aldosterone deficiency. Hypertension is a common feature of APS; in patients with APS and AD, replacement therapy with glucocorticoids and mineralocorticoids may jeopardize hypertension management.
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spelling pubmed-62801322018-12-10 Addison’s disease in antiphospholipid syndrome: a rare complication Oliveira, Diana Ventura, Mara Melo, Miguel Paiva, Sandra Carrilho, Francisco Endocrinol Diabetes Metab Case Rep Unique/Unexpected Symptoms or Presentations of a Disease Addison’s disease (AD) is the most common endocrine manifestation of antiphospholipid syndrome (APS), but it remains a very rare complication of the syndrome. It is caused by adrenal venous thrombosis and consequent hemorrhagic infarction or by spontaneous (without thrombosis) adrenal hemorrhage, usually occurring after surgery or anticoagulant therapy. We present a clinical case of a 36-year-old female patient with a previous diagnosis of APS. She presented with multiple thrombotic events, including spontaneous abortions. During evaluation by the third episode of abortion, a CT imaging revealed an adrenal hematoma, but the patient was discharged without further investigation. A few weeks later, she presented in the emergency department with manifestations suggestive of adrenal insufficiency. Based on that assumption, she started therapy with glucocorticoids, with significant clinical improvement. After stabilization, additional investigation confirmed AD and excluded other etiologies; she also started mineralocorticoid replacement. This case illustrates a rare complication of APS that, if misdiagnosed, may be life threatening. A high index of suspicion is necessary for its diagnosis, and prompt treatment is crucial to reduce the morbidity and mortality potentially associated. LEARNING POINTS: AD is a rare but life-threatening complication of APS. It is important to look for AD in patients with APS and a suggestive clinical scenario. APS must be excluded in patients with primary adrenal insufficiency and adrenal imaging revealing thrombosis/hemorrhage. Glucocorticoid therapy should be promptly initiated when AD is suspected. Mineralocorticoid replacement must be started when there is confirmed aldosterone deficiency. Hypertension is a common feature of APS; in patients with APS and AD, replacement therapy with glucocorticoids and mineralocorticoids may jeopardize hypertension management. Bioscientifica Ltd 2018-11-22 /pmc/articles/PMC6280132/ /pubmed/30481151 http://dx.doi.org/10.1530/EDM-18-0118 Text en © 2018 The authors http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB) .
spellingShingle Unique/Unexpected Symptoms or Presentations of a Disease
Oliveira, Diana
Ventura, Mara
Melo, Miguel
Paiva, Sandra
Carrilho, Francisco
Addison’s disease in antiphospholipid syndrome: a rare complication
title Addison’s disease in antiphospholipid syndrome: a rare complication
title_full Addison’s disease in antiphospholipid syndrome: a rare complication
title_fullStr Addison’s disease in antiphospholipid syndrome: a rare complication
title_full_unstemmed Addison’s disease in antiphospholipid syndrome: a rare complication
title_short Addison’s disease in antiphospholipid syndrome: a rare complication
title_sort addison’s disease in antiphospholipid syndrome: a rare complication
topic Unique/Unexpected Symptoms or Presentations of a Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280132/
https://www.ncbi.nlm.nih.gov/pubmed/30481151
http://dx.doi.org/10.1530/EDM-18-0118
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