Adrenal Hemorrhage Causing Adrenal Insufficiency in a Patient with Antiphospholipid Syndrome: Increased Adrenal 18F-FDG Uptake

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 cardiacarrestandhypotensionrequiringresuscitation.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 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)wasperformedinsearchofaninflammatoryfocus. 18 F-FDG uptake was increased in both adrenal glands,