Behera Kishore Kumar, Kapoor Nitin, Seshadri M S, Rajaratnam Simon
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Endocrinol Metab. 2013 Oct;17(Suppl 1):S240-2. doi: 10.4103/2230-8210.119584.
We report a case of acute adrenal insufficiency (AAI) in a patient with antiphospholipid syndrome (APS).
A 44-year-old female patient presented to us with acute abdominal pain associated with recurrent vomiting and giddiness. On examination, her blood pressure was 80/50 mm Hg. Systemic examination was normal. Further evaluation revealed hypocortisolemia with elevated plasma adrenocorticotropin hormone indicative of primary adrenal insufficiency. Her abdominal computed tomography scan showed features of evolving bilateral adrenal infarction. Etiological work-up revealed prolonged activated thromboplastin time, which didn't correct with normal plasma, her anti-cardiolipin antibody and lupus anticoagulant were also positive. She was diagnosed to have APS with adrenal insufficiency and she was started on intravenous steroids and heparin infusion.
AAI due to the APS can present with acute abdominal pain followed by hypotension. A high index of suspicion is needed to make the correct diagnosis and to initiate appropriate treatment.
我们报告一例抗磷脂综合征（APS）患者发生急性肾上腺功能不全（AAI）的病例。
一名44岁女性患者因急性腹痛伴反复呕吐和头晕前来就诊。检查时，她的血压为80/50 mmHg。全身检查正常。进一步评估发现皮质醇水平降低，血浆促肾上腺皮质激素升高，提示原发性肾上腺功能不全。她的腹部计算机断层扫描显示双侧肾上腺梗死进展的特征。病因学检查显示活化部分凝血活酶时间延长，且不能被正常血浆纠正，她的抗心磷脂抗体和狼疮抗凝物也呈阳性。她被诊断为APS合并肾上腺功能不全，并开始接受静脉注射类固醇和肝素治疗。
APS导致的AAI可表现为急性腹痛，随后出现低血压。需要高度怀疑才能做出正确诊断并启动适当治疗。
