Godfrey Rebecca Louise, Clark James, Field Benjamin
Frimley Health NHS Foundation Trust, Frimley, UK.
Surrey & Sussex Healthcare NHS Trust, Redhill, UK.
BMJ Case Rep. 2014 Nov 19;2014:bcr2014207050. doi: 10.1136/bcr-2014-207050.
A 68-year-old woman with antiphospholipid syndrome presented with a 3-day history of bilateral loin pain, vomiting, fever and confusion. On examination she was febrile, hypotensive and tachycardic. Investigations revealed raised inflammatory markers, renal impairment and hyponatraemia. Abdominal ultrasound revealed two well-defined heterogeneous areas bilaterally in the region of the adrenal glands. This prompted serum cortisol measurement and a CT of the abdomen. Cortisol was low in the context of sepsis at 48 nmol/L, and CT confirmed bilateral heterogeneous adrenal pathology. The patient was managed for septic shock and adrenal insufficiency. She was recognised to have several risk factors for haemorrhagic infarction of the adrenals: antiphospholipid syndrome, sepsis, postoperative state and anticoagulant therapy. She was discharged well on glucocorticoid and mineralocorticoid therapy and a repeat CT at 4 weeks confirmed the diagnosis of bilateral adrenal infarct and haemorrhage.
一名68岁的抗磷脂综合征女性患者，出现双侧腰痛、呕吐、发热和意识模糊3天。检查发现她发热、低血压且心动过速。检查显示炎症标志物升高、肾功能损害和低钠血症。腹部超声显示双侧肾上腺区域有两个边界清晰的不均匀区域。这促使进行血清皮质醇测定和腹部CT检查。在脓毒症情况下，皮质醇水平较低，为48 nmol/L，CT证实双侧肾上腺存在不均匀病变。患者接受了感染性休克和肾上腺功能不全的治疗。她被认为有肾上腺出血性梗死的几个危险因素：抗磷脂综合征、脓毒症、术后状态和抗凝治疗。她在接受糖皮质激素和盐皮质激素治疗后康复出院，4周后复查CT确诊为双侧肾上腺梗死和出血。
