Abstract #805950: Post Partum Unilateral Adrenal Infarction in a Patient with Antiphospholipid Syndrome

2020 ◽  
Vol 26 ◽  
pp. 20-21
Author(s):  
Sarah Chhabra
Keyword(s):  
Antiphospholipid Syndrome ◽  
Post Partum ◽  
Adrenal Infarction

Bleeding complications and antithrombotic treatment in 264 pregnancies in antiphospholipid syndrome

Lupus ◽  
2018 ◽  
Vol 27 (10) ◽  
pp. 1679-1686 ◽  
Author(s):  
C M Yelnik ◽  
M Lambert ◽  
E Drumez ◽  
V Le Guern ◽  
J-L Bacri ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Major Bleeding ◽  
Pregnancy Outcomes ◽  
Prospective Cohort ◽  
Retrospective Cohort ◽  
Post Partum ◽  
Bleeding Complications ◽  
Minor Bleeding ◽  
Increased Risk ◽  
History Of

Purpose The purpose of this study was to evaluate the safety of antithrombotic treatments prescribed during pregnancy in patients with antiphospholipid syndrome (APS). Methods This international, multicenter study included two cohorts of patients: a retrospective French cohort and a prospective US cohort (PROMISSE study). Inclusion criteria were (1) APS (Sydney criteria), (2) live pregnancy at 12 weeks of gestation (WG) with (3) follow-up data until six weeks post-partum. According to APS standard of care, patients were treated with aspirin and/or low-molecular weight heparin (LMWH) at prophylactic (pure obstetric APS) or therapeutic doses (history of thrombosis). Major bleeding was defined as abnormal blood loss during the pregnancy and/or post-partum period requiring intervention for hemostasis or transfusion, or during the peripartum period greater than 500 mL and/or requiring surgery or transfusion. Other bleeding events were classified as minor. Results Two hundred and sixty-four pregnancies (87 prospectively collected) in 204 patients were included (46% with history of thrombosis, 23% with associated systemic lupus). During pregnancy, treatment included LMWH ( n = 253; 96%) or low-dose aspirin ( n = 223; 84%), and 215 (81%) patients received both therapies. The live birth rate was 89% and 82% in the retrospective and prospective cohorts, respectively. Adverse pregnancy outcomes occurred in 28% of the retrospective cohort and in 40% of the prospective cohort. No maternal death was observed in either cohort. A combined total of 45 hemorrhagic events (25%) occurred in the retrospective cohort, but major bleeding was reported in only six pregnancies (3%). Neither heparin nor aspirin alone nor combined therapy increased the risk of hemorrhage. We also did not observe an increased rate of bleeding in the case of a short interval between last LMWH (less than 24 hours) or aspirin (less than five days) doses and delivery. Only emergency Caesarean section was significantly associated with an increased risk of bleeding (odds ratio (OR) 5.03 (1.41–17.96); p=.016). In the prospective cohort, only one minor bleeding event was reported (vaginal bleeding). Conclusion Our findings support the safety of antithrombotic therapy with aspirin and/or LMWH during pregnancy in high-risk women with APS, and highlight the need for better treatments to improve pregnancy outcomes in APS. PROMISSE Study ClinicalTrials.gov identifier: NCT00198068.

scholarly journals Primary adrenal insufficiency due to bilateral adrenal infarction in COVID-19: a case report

2021 ◽  
Author(s):  
Iza F R Machado ◽  
Isabel Q Menezes ◽  
Sabrina R Figueiredo ◽  
Fernando Morbeck Almeida Coelho ◽  
Debora R B Terrabuio ◽  
...  
Keyword(s):  
Case Report ◽  
Adrenal Insufficiency ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Case Reports ◽  
Serum Cortisol ◽  
Primary Adrenal Insufficiency ◽  
Acute Adrenal Insufficiency ◽  
Adrenal Infarction ◽  
New Onset

Abstract Context Coronavirus disease 2019 (COVID-19) is a proinflammatory and prothrombotic condition, but its impact on adrenal function has not been adequately evaluated. Case report A 46-year-old woman presented with abdominal pain, hypotension, skin hyperpigmentation after COVID-19 infection. The patient had hyponatremia, serum cortisol <1.0 ug/dL, ACTH of 807 pg/mL and aldosterone <3 ng/dL. Computed tomography (CT) findings of adrenal enlargement with no parenchymal and minimal peripheral capsular enhancement after contrast were consistent with bilateral adrenal infarction. The patient had autoimmune hepatitis and positive antiphospholipid antibodies, but no previous thrombotic events. The patient was treated with intravenous hydrocortisone, followed by oral hydrocortisone and fludrocortisone. Discussion Among 115 articles, we identified nine articles, including case reports, of new-onset adrenal insufficiency and/or adrenal hemorrhage/infarction on CT in COVID-19. Adrenal insufficiency was hormonally diagnosed in five cases, but ACTH levels were measured in only three cases (high in one case and normal/low in other two cases). Bilateral adrenal non- or hemorrhagic infarction was identified in five reports (two had adrenal insufficiency, two had normal cortisol levels and one case had no data). Interestingly, the only case with well-characterized new-onset acute primary adrenal insufficiency after COVID-19 had a previous diagnosis of antiphospholipid syndrome. In our case, antiphospholipid syndrome diagnosis was established only after the adrenal infarction triggered by COVID-19. Conclusions Our findings support the association between bilateral adrenal infarction and antiphospholipid syndrome triggered by COVID-19. Therefore, patients with positive antiphospholipid antibodies should be closely monitored for symptoms or signs of acute adrenal insufficiency during COVID-19.

BILATERAL ADRENAL INFARCTION, HYPOADRENALISM AND SPLINTER HAEMORRHAGES IN THE ‘PRIMARY’ ANTIPHOSPHOLIPID SYNDROME

Rheumatology ◽  
1992 ◽  
Vol 31 (2) ◽  
pp. 117-120 ◽  
Author(s):  
D. E. AMES ◽  
R. A. ASHERSON ◽  
B. AYRES ◽  
J. CASSAR ◽  
G. R. V. HUGHES
Keyword(s):  
Antiphospholipid Syndrome ◽  
Primary Antiphospholipid Syndrome ◽  
Adrenal Infarction

scholarly journals Post-partum bilateral renal cortical necrosis in antiphospholipid syndrome and systemic lupus erythematosus

2013 ◽  
Vol 24 (3) ◽  
pp. 549 ◽  
Author(s):  
Sivakumar Vishnubhotla ◽  
VenkatSainaresh Vellanki ◽  
Sriramnaveen Parvathina ◽  
Sivaramakrishna Gondi ◽  
KrishnaKishore Chenu ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Post Partum ◽  
Systemic Lupus ◽  
Cortical Necrosis ◽  
Renal Cortical Necrosis

scholarly journals Post-partum cutaneous manifestation of antiphospholipid syndrome

2019 ◽  
Vol 18 ◽  
pp. 200334
Author(s):  
Yumeng Zhang ◽  
Nicole D. Riddle ◽  
Lucia Seminario-Vidal
Keyword(s):  
Antiphospholipid Syndrome ◽  
Post Partum ◽  
Cutaneous Manifestation

scholarly journals Primary Adrenal Insufficiency Due to Bilateral Adrenal Hemorrhage-Adrenal Infarction in the Antiphospholipid Syndrome: Long-Term Outcome of 16 Patients

2013 ◽  
Vol 98 (8) ◽  
pp. 3179-3189 ◽  
Author(s):  
Isolde Ramon ◽  
Alexis Mathian ◽  
Anne Bachelot ◽  
Baptiste Hervier ◽  
Julien Haroche ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Acute Phase ◽  
Antiphospholipid Syndrome ◽  
Adrenal Hemorrhage ◽  
Primary Adrenal Insufficiency ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Bilateral Adrenal Hemorrhage ◽  
Adrenal Infarction

Context: Primary adrenal insufficiency due to bilateral adrenal hemorrhage-adrenal infarction is a rare and life-threatening manifestation of the antiphospholipid syndrome (APLS). Data on the long-term outcome are scarce. Objective: The aims of the present study were to analyze the long-term outcome related to APLS per se and to characterize the course of adrenal involvement. Design: We conducted a retrospective study of patients with bilateral adrenal hemorrhage-adrenal infarction secondary to APLS seen in the Department of Internal Medicine of Pitié-Salpêtrière Hospital in Paris (France) between January 1990 and July 2010. Results: Three patients died during the acute phase related to APLS manifestations. Sixteen patients (7 males; 9 females) were followed up during a median period of 3.5 years (range 0.3–28.1 years). Three episodes of recurrent thrombosis were noted. One patient died from cerebral hemorrhage 3 months after the onset of adrenal insufficiency. Repeated Synacthen tests showed complete absence of response in 8 of the 10 patients assessed; cortisol and aldosterone increased appropriately in one patient and to some extent in another one. Dehydroepiandrosterone levels and 24-hour urinary epinephrine levels remained abnormally low in all evaluated patients. Adrenal imaging performed more than 1 year after the initial event revealed completely atrophic glands in 9 of 11 patients. Conclusions: This particular subset of APLS patients who survive the acute phase has a rather favorable long-term outcome. Although adrenal dysfunction is generally irreversible, adrenocortical function may, at least partially, recover in rare cases. In this view, measurement of early morning cortisol during follow-up is indicated to detect these patients.

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