Endocrine Abstracts

A 63-year-old lady was admitted with a 10 day history of central abdominal pain associated with constipation and vomiting. She was diagnosed with myelodyplasia 11 years previously and required regular blood transfusions but was otherwise fit and well. On this presentation, she was apyrexial with a heart rate of 72 beats per minute and blood pressure of 170/74. Her abdomen was soft with mild periumbilical tenderness. Routine blood investigations showed haemoglobin of 10.2 g/dl and white cell count 15 10*9/l, platelet count 356. Electrolytes, renal and liver function tests were normal. An abdominal radiograph revealed large bowel dilatation; therefore a CT scan of her abdomen was arranged. The CT excluded bowel obstruction but noted bilateral adrenal enlargement (right 3×3.8 cm, left 3.1×2.5 cm) and splenic infarction. Short synacthen test showed a flat response (cortisol 40 nmol/l baseline, 42 nmol/l at 30 min). She was commenced on adrenal replacement therapy (hydrocortisone and fludrocortisone) as well as anticoagulated for presumed adrenal infarction. Adrenal antibodies tests were negative. Serial CT scans over the following months showed shrinkage of the adrenal glands confirming bilateral adrenal infarction. Thrombosis of the inferior vena cava was noted on subsequent CT scans. Investigations undertaken to exclude a hypercoaguable state, including an autoimmune profile, ANCA, Factor V Leiden mutation, prothrombin 20210a variant, cardiolipin antibody, lupus anticoagulant and tests for paroxysmal nocturnal haemoglobinuria, returned negative. It is postulated that her infarctions may have been triggered by myelodysplastic syndrome with associated platelet dysfunction. To our knowledge, there are no other reported cases of bilateral adrenal infarction associated with myelodysplasia.