A 45-yr-old woman with antiphospholipid syndrome (APS) and a history of recurrent thromboembolic events was admitted with hematothorax while on acenocoumarol. Recovery was complicated by cardiac arrest and hypotension requiring resuscitation. She subsequently developed fever and abdominal distress coincided by hyponatremia, hyperkalemia, and eosinophilia. An insufficient rise in serum cortisol after synthetic ACTH (20 nmol/liter maximally), together with an undetectable aldosterone and elevated

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... ACTH (278 ng/liter) confirmed primary adrenal insufficiency. Glucocorticoid and mineralocorticoid administration improved her condition. Antiadrenal antibodies were absent. Plasma metanephrines were normal. Integrated 2-[fluorine 18] fluoro-2-deoxy-D glucose ( 18 F-FDG) positron emission tomography/computed tomography (CT) was performed in search of an inflammatory focus. 18 F-FDG uptake was increased in both adrenal glands, particularly in the left, which remained enlarged on subsequent CT (Fig.