You Jee Young, Fleischer Norman, Abraham Smita B
AACE Clin Case Rep. 2019 Aug 15;5(6):e334-e339. doi: 10.4158/ACCR-2019-0167. eCollection 2019 Nov-Dec.
To describe a case of sequential bilateral adrenal infarction and hemorrhage resulting in an unusual pattern of adrenal function over time.
A 50-year-old male with autoimmune antiphospholipid syndrome (APS) presented to the emergency room with severe abdominal pain. Diagnostic studies performed included contrast-enhanced computerized tomographic (IV-CT) imaging of abdomen and pelvis, and laboratory assessment of the hypothalamic-pituitary-adrenal axis.
IV-CT of abdomen and pelvis on day 1 showed acute left adrenal gland infarction; cortisol level was 19.9 μg/dL and serum sodium was 133 mEq/L. The patient subsequently developed hyponatremia and hypotension. Repeat IV-CT of abdomen and pelvis on day 3 showed hemorrhagic conversion of the left infarcted adrenal gland and a new right adrenal gland infarction. Cosyntropin stimulation test (CST) confirmed primary glucocorticoid insufficiency. Plasma renin activity and the serum aldosterone level were within normal limits with normokalemia. At 7-month follow-up, CST demonstrated cortisol and aldosterone deficiency.
Adrenal infarction is a rare complication of APS but is the most common endocrine complication. Evidence of bilateral adrenal infarction on imaging does not predict the type of adrenal dysfunction that might ensue, as demonstrated in this case. Thorough evaluation of glucocorticoid, mineralocorticoid, and androgen deficiency should be conducted both at the time of the event and in follow-up.
描述一例双侧肾上腺先后发生梗死和出血导致肾上腺功能随时间呈现异常模式的病例。
一名患有自身免疫性抗磷脂综合征（APS）的50岁男性因严重腹痛就诊于急诊室。进行的诊断性检查包括腹部和骨盆的增强计算机断层扫描（IV-CT）成像，以及下丘脑-垂体-肾上腺轴的实验室评估。
第1天腹部和骨盆的IV-CT显示急性左肾上腺梗死；皮质醇水平为19.9μg/dL，血清钠为133mEq/L。患者随后出现低钠血症和低血压。第3天重复进行的腹部和骨盆IV-CT显示左梗死肾上腺发生出血性转化以及新出现的右肾上腺梗死。促肾上腺皮质激素刺激试验（CST）证实原发性糖皮质激素不足。血浆肾素活性和血清醛固酮水平在正常范围内，血钾正常。在7个月的随访中，CST显示皮质醇和醛固酮缺乏。
肾上腺梗死是APS的一种罕见并发症，但却是最常见的内分泌并发症。如本病例所示，影像学上双侧肾上腺梗死的证据并不能预测可能随之出现的肾上腺功能障碍类型。在事件发生时及随访过程中均应对糖皮质激素、盐皮质激素和雄激素缺乏进行全面评估。
