Unilateral non-haemorrhagic adrenal infarction during the puerperium in a patient with antiphospholipid syndrome

Abstract

The leading complication of antiphospholipid syndrome (APS) is arterial and venous thrombotic diathesis, which usually manifests as deep vein thrombosis or cerebrovascular events. However, it can occur in any blood vessel, rarely including the adrenal vessels. This can be the first manifestation of APS, and it is frequently bilateral and triggers adrenal insufficiency (Addison’s disease). It has been proposed that the initial phenomenon is thrombosis of the adrenal veins leading to infarction. Bilateral involvement is usually irreversible and requires permanent hormone replacement therapy. Unilateral involvement is even more infrequent and appears to have a better prognosis. We report the case of a 35-year-old female patient with a history of APS (repeated spontaneous abortions, livedo reticularis, presence of antiphospholipid antibodies and lupus anticoagulant), who presented with right adrenal infarction during the puerperium and whose clinical manifestation was sudden and severe lumbar pain. The diagnosis was made with contrast enhanced tomography. The patient made satisfactory progress, with no evidence of adrenal insufficiency.