Adrenal insufficiency as the first clinical manifestation of the primary antiphospholipid antibody syndrome

We describe a 60-year-old man who developed clinical symptoms and signs of Addison's disease, which was subsequently confirmed biochemically; no cause was apparent. Several months later the patient represented with a fit, fol lowed by a large and extensive venous thrombosis in the right iliac vein an d in the veins of the right leg. He had strongly positive antibodies to car diolipin, strongly suggesting a diagnosis of primary antiphospholipid syndr ome. While Addison's disease is a well-recognized, albeit rare, manifestati on of the antiphospholipid syndrome, the Addison's disease preceded other c linical evidence of the syndrome by several months, in our patient, at vari ance with previous cases described in the literature. The antiphospholipid syndrome should be considered as a possible pathogenetic process in patient s presenting with Addison's disease where the aetiology is not obvious.