Endocrine Abstracts

A previously well 54 year old man, with no atherosclerotic risk factors, presented with a 10 month history of claudication. Arteriography showed extensive distal aortic and iliac stenoses.

At surgery, (Aortoiliac and femoral bypass) extensive thrombus was found in the distal aorta. Post operatively good distal flow was confirmed. He was discharged on Aspirin.

Fourteen days later the patient was readmitted hypotensive, pyrexic, with suspected graft thrombosis and sepsis. Reperfusion was achieved with infusion of Heparin.

Spiral CT showed occlusion of the distal aortic graft and bilaterally haemorrhagic adrenal glands. At this stage the patient was inotrope dependent with deteriorating renal function in ITU. He was given 50 mg hydrocortisone tid because of the possibility of hypoadrenalism.

At surgery the graft was removed but the replacement graft became extensively thrombosed intra-operatively requiring further heparin infusion.

Seven days post operatively after discharge from ITU a Synacthen test confirmed hypoadrenalism - Pre-test 108 nmol/l, Post-test 123 nmol/l. Thrombophilia screening yielded a significantly elevated anticardiolipin antibody titre. Negative serology for SLE indicated that the patient had primary Antiphospholipid syndrome. Steroid replacement was continued and warfarinisation commenced. Subsequent recovery was uncomplicated. The patient remains well on adrenal replacement therapy, Aspirin and Warfarin.

The Antiphospholipid syndrome (Hughes syndrome) is the association of Antiphospholipid antibodies with venous and arterial thrombosis and pregnancy morbidity. This case illustrates both arterial thrombosis and adrenal haemorrhage as manifestations of the Antiphospholipid syndrome. This syndrome must be remembered as a possible cause of Addisons disease of acute onset.