MASSIVE BILATERAL ADRENAL HEMORRHAGE AND ADRENAL CRISIS IN 2 PATIENTSWITH THE PRIMARY ANTIPHOSPHOLIPID SYNDROME

A small number of cases of patients with the primary antiphospholipid (APL) syndrome who developed massive bilateral adrenal hemorrhage have been described. We describe two additional cases of patients with the primary APL syndrome who developed massive bilateral adrenal hemorrha ge. Case 1: A 68 year-old man who previously was diagnosed with the pr imary APL syndrome sustained a myocardial infarction associated with a lower gastrointestinal hemorrhage. He was maintained on warfarin ther apy. Computed tomography (CT) of the abdomen revealed bilateral adrena l hemorrhage. The patient subsequently developed an adrenal crisis. Ca se 2: A previously healthy 39-year-old man presented with right-sided abdominal pain. He was discovered to have a right renal infarction, an d intravenous heparin therapy was begun. Within 48 hours he developed an adrenal crisis. An abdominal CT scan confirmed bilateral adrenal he morrhage. The patient ultimately was found to have a low titer of immu noglobulin M anticardiolipin antibodies. Con elusion: Massive bilatera l adrenal hemorrhage can complicate the primary APL syndrome. Patients who develop unexplained bilateral adrenal hemorrhage should be tested for the primary APL syndrome because it may be an early manifestation of the disease.