Adrenal insufficiency is an uncommon, life threatening complication of the primary antiphospholipid antibody syndrome (PAPS), secondary to either adrenal haemorrhage or infarction.1-6Adrenal failure more often follows other PAPS thromboembolic manifestations, and has to be clearly differentiated from other PAPS abdominal emergencies, including mesenteric and hepatic infarction.1 ,3-5 The pathological mechanisms involved are still not clearly understood, but the hypercoagulable state in patients with PAPS supports the concept that adrenal haemorrhagic infarction may possibly be related to adrenal vein thrombosis.7 We recently observed a new case, which is of particular interest as the patient developed an acute adrenal failure, revealing bilateral adrenal infarction, as a first manifestation of the PAPS.

A 70 year old patient presented with diffuse abdominal pain persisting for 15 days. He had …