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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 elevateddoi:10.1210/jc.2012-2050 pmid:22701015 fatcat:qke4w7ohxjhfnhlfjb5v2dvtee