Bilateral adrenal infarction and insufficiency associated with antiphospholipid syndrome and surgery: A case report

Background: Antiphospholipid syndrome causes systemic arterial and venous thromboses owing to the presence of antiphospholipid antibodies. Adrenal insufficiency is a rare complication of antiphospholipid syndrome. If left untreated, adrenal insufficiency may result in fatal outcomes. Case presentation: A 64-year-old man underwent surgery for a left traumatic hemothorax. He concurrently had antiphospholipid syndrome and was receiving warfarin. Postoperatively, he complained of severe lumbar back pain, despite resuming anticoagulation therapy. He developed paralytic ileus and shock. Abdominal contrast-enhanced computed tomography revealed adrenal swelling and increased surrounding retroperitoneal adipose tissue density. Diffusion-weighted abdominal magnetic resonance imaging revealed high-intensity areas in the bilateral adrenal glands. The cortisol and adrenocorticotropic hormone levels were 3.30 µg/dL and 185.1 pg/dL, respectively. The patient was diagnosed with bilateral adrenal infarction and acute adrenal insufficiency. Hydrocortisone was immediately administered. Adrenal insufficiency improved gradually. The patient was discharged after initiating steroid replacement therapy. Conclusions The timing of postoperative anticoagulant therapy initiation is controversial. AI due to adrenal infarction should be monitored while anticoagulant therapy is discontinued in patients with APS.