Primary adrenal insufficiency due to recurrent episodes of unilateral adrenal infarction

Saori Kitayama; Yasufumi Seki; Yutaka Kato; Saya Takebe; Makiko Ikemoto; Yuko Inoue; Kiyotaka Hirata; Kaoru Yamashita; Noriyoshi Takano; Daisuke Watanabe; Satoshi Morimoto; Atsuhiro Ichihara

doi:10.1530/endoabs.110.EP150

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Endocrine Abstracts (2025) 110 EP150 | DOI: 10.1530/endoabs.110.EP150

ECEESPE2025 ePoster Presentations Adrenal and Cardiovascular Endocrinology (170 abstracts)

Primary adrenal insufficiency due to recurrent episodes of unilateral adrenal infarction

Saori Kitayama ¹ , Yasufumi Seki ¹ , Yutaka Kato ² , Saya Takebe ¹ , Makiko Ikemoto ¹ , Yuko Inoue ¹ , Kiyotaka Hirata ¹ , Kaoru Yamashita ¹ , Noriyoshi Takano ¹ , Daisuke Watanabe ¹ , Satoshi Morimoto ¹ & Atsuhiro Ichihara ¹

Author affiliations

¹Tokyo Women’s Medical University, Department of Endocrinology and Hypertension, Tokyo, Japan; ²Tokyo Women’s Medical University, Department of Hematology, Tokyo, Japan

JOINT1244

Introduction: Adrenal infarction is a rare cause of primary adrenal insufficiency that usually occurs in hypercoagulable states, resulting in life-threatening conditions. Most cases of adrenal infarction involve bilateral lesions complicated with adrenal insufficiency or a unilateral lesion without adrenal insufficiency. Cases of unilateral adrenal infarction resulting in adrenal insufficiency have been rarely reported. Herein, we present a case of recurrent episodes of unilateral adrenal infarction leading to adrenal insufficiency.

Case description: A 72-year-old woman with a history of myelodysplastic syndrome and cerebral infarction presented with sudden-onset left lumbago. The patient had taken lenalidomide for 13 months and cilostazol for thrombocytosis and prevention of cerebral infarction. Abdominal enhanced CT revealed a left swollen adrenal gland with a low-enhanced area and MRI showed a restricted diffusion of the ischemic adrenal gland, confirming the diagnosis as left adrenal infarction. The cosyntropin test revealed a peak cortisol level of 16.9 μg/dL, indicating normal adrenal function. Despite the cessation of lenalidomide, the 2nd episode of adrenal infarction developed on the right adrenal gland 3 months after the 1st episode of adrenal infarction. Plasma levels of adrenocorticotropic hormone, cortisol, and peak cortisol response to 250 μg of cosyntropin were 1996 pg/mL, 27.8 μg/dL, and 14.8 μg/dL, respectively, indicating primary adrenal insufficiency and the patient started to take 15 mg of hydrocortisone.

Conclusion: We present a case of recurrent unilateral adrenal infarction causing bilateral adrenal infarction and adrenal insufficiency. Unilateral adrenal insufficiency is rare but can cause adrenal insufficiency when it repeatedly develops on the bilateral adrenal glands.