Skip to main content

Advertisement

SpringerLink
Log in

Adrenal gland abnormalities detected by magnetic resonance imaging in patients with antiphospholipid syndrome

Magnetresonanztomographisch detektierte Nebennierenanomalien bei Patienten mit Antiphospholipidsyndrom

  • Originalien
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Abstract

Background

Adrenal infarction is a rare complication of antiphospholipid syndrome (APS).

Objectives

The purpose of the current study is to detect and study the magnetic resonance imaging (MRI) findings of adrenal glands in APS patients.

Materials and methods

In a cross-sectional study, the data of 20 patients with primary or secondary APS were compared to 20 SLE patients without antiphospholipid antibody (aPL) syndrome (controls). MRI of the abdomen showing the adrenal glands was performed.

Results

Of the patients, 80% were females with a mean age 32.45 ± 9.93 years, and mean disease duration of 46.65 ± 58.71 months. Adrenal gland abnormalities in the MRI study were detected in 35 % of APS patients vs. no abnormalities detected in the SLE controls. Adrenal gland enlargement was found in all patients (35 %). Capsular enhancement (infarction or hemorrhagic infarction) was found in 5 patients, increased stranding of the surrounding fat planes (inflammatory process) in 4 patients and increased signal on T1WI and T2WI (hemorrhage) in 3 patients. In patients with adrenal gland involvement, 71.4 % had triple aPL positivity compared to 23.1 % in patients with normal adrenal findings (p = 0.04).

Conclusions

Adrenal gland abnormalities on MRI were detected in 35 % of the APS patients (whether primary or secondary); thus, increased focus on management is needed. This percentage is not small and needs to be focused on in terms of management.

Zusammenfassung

Hintergrund

Ein Nebenniereninfarkt ist eine seltene Komplikation bei Antiphospholipidsyndrom (APS).

Zielsetzung

Ziel der vorliegenden Studie ist die Untersuchung von MRT(Magnetresonanztomographie)-Befunden der Nebennieren in einer Gruppe von APS-Patienten.

Material und Methoden

In dieser Querschnittsstudie wurden die von 20 Patienten mit primären oder sekundären APS mit denen von 20 SLE(systemischer Lupus erythematosus)-Patienten ohne Antiphospholipidantikörper (aPL) verglichen. Durchgeführt wurden abdominelle MRTs mit Darstellung der Nebennieren.

Ergebnisse

Von allen Patienten waren 80% Frauen mit einem Durchschnittsalter 32,45 ± 9,93 Jahre, die mittlere Krankheitsdauer lag bei 46,65 ± 58,71 Monaten. In den MRTs wurden bei 35 % der APS-Patienten Anomalien detektiert, im SLE-Kontrollkollektiv dagegen bei keinem. Eine Vergrößerung der Nebenniere bestand bei allen Patienten (35 %), ein kapsuläres Enhancement (Infarkt bzw. hämorrhagischer Infarkt) bei 5, vermehrtes Stranding im periadrenalen Fettgewebe (entzündlicher Prozess) bei 4 und erhöhte T1W- und T2W-Signalwerte (Blutung) bei 3 Patienten. Von den Patienten mit adrenaler Beteiligung wiesen 71,4 % eine Triple-aPL-Positivität auf, von den Patienten mit unauffälligen Nebennierenbefunden dagegen nur 23,1% (p = 0,04).

Schlussfolgerungen

Nebennierenanomalien wurden magnetresonanztomographisch bei 35 % der APS-Patienten nachgewiesen, was die Notwendigkeit einer stärkeren Fokussierung auf das entsprechende Management verdeutlicht. Hinsichtlich des Patientenmanagements ist dieser nicht unerhebliche Prozentsatz zu bedenken.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Charles E (2009) Antiphospholipid syndrome review. Clin Lab Med 29(2):305–319

    Article  Google Scholar 

  2. Levine JS, Branch DW, Rauch J (2002) The antiphospholipid syndrome. N Engl J Med 346(10):752–763

    Article  CAS  PubMed  Google Scholar 

  3. Piette JC, Wechsler B, Frances C, Papo T, Godeau P (1993) Exclusion criteria for primary antiphospholipid syndrome. J Rheumatol 20:1802–1804

    CAS  PubMed  Google Scholar 

  4. Merkel PA, Chang Y, Pierangeli SS, Convery K, Harris EN, Polisson RP (1996) The prevalence and clinical associations of anticardiolipin antibodies in a large inception cohort of patients with connective tissue diseases. Am J Med 101(6):576–583

    Article  CAS  PubMed  Google Scholar 

  5. Miyakis S, Lockshin MD, Atsumi T et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 4:295–306

    Article  CAS  PubMed  Google Scholar 

  6. Zoghlami-Rintelen C, Vormittag R, Sailer T et al (2005) The presence of IgG antibodies against beta2-glycoprotein I predicts the risk of thrombosis in patients with the lupus anticoagulant. J Thromb Haemost 3:1160–1165

    Article  CAS  PubMed  Google Scholar 

  7. Papadopoulos KI, Jönsson A, Berntorp E, Törnquist C, Hulthén UL (1995) Primary antiphospholipid syndrome associated with postoperative primary adrenal failure. J Intern Med 238:175–178

    Article  CAS  PubMed  Google Scholar 

  8. Elsayes KM, Mukundan G, Narra VR et al (2004) Adrenal masses: MR imaging features with pathologic correlation. Radiographics 24(Suppl 1):73–86

    Article  Google Scholar 

  9. Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725 doi:10.1002/art.1780400928

    Article  CAS  PubMed  Google Scholar 

  10. Petri M, Genovese M, Engle E, Hochberg M (1991) Definition, incidence and clinical description of flare in systemic lupus erythematosus. Arthritis Rheum 8:937–944

    Article  Google Scholar 

  11. Abrahamowicz M, Fortin PR, Berger R du, Nayak R, Neville C, Liang MH (1998) The relationship between disease activity and expert physician’s decision to start major treatment in active systemic lupus erythematosus: a decision aid for development of entry criteria for clinical trials. J Rheumatol 25:277–284

    CAS  PubMed  Google Scholar 

  12. Brandt JT, Triplett DA, Alving B et al (1995) Criteria for the diagnosis of lupus anticoagulants: an update. On behalf of the Subcommittee on Lupus anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the ISTH. Thromb Haemost 74:1185–1190

    CAS  PubMed  Google Scholar 

  13. Takebayashi K, Aso Y, Tayama K, Takemura Y, Inukai T (2003) Primary antiphospholipid syndrome associated with acute adrenal failure. Am J Med Sci 325:41–44

    Article  CAS  PubMed  Google Scholar 

  14. Espinosa G, Santos E, Cervera R et al (2003) Adrenal involvement in the antiphospholipid syndrome clinical and immunologic characteristics of 86 Patients. Medicine (Baltimore) 82(2):106–118

    Article  Google Scholar 

  15. Arnason JA, Graziano FM (1995) Adrenal insufficiency in the antiphospholipid antibody syndrome. Semin Arthritis Rheum 25:109–116

    Article  CAS  PubMed  Google Scholar 

  16. Carvalho JF de, Caleiro MT, Vendramini M, Bonfá E (2010) Clinical and laboratory evaluation of patients with primary antiphopholipid syndrome according to the frequency of antinuclear antibody (ANA Hep-2). Rev Bras Reumatol 5(3):262–272

    Article  Google Scholar 

  17. Dahiya S, Bhagavan A, Ooi WB (2012) Spontaneous bilateral adrenal hemorrhage. Endocrine 42(1):226–227. doi:10.1007/s12020-012-9678-z

    Article  CAS  PubMed  Google Scholar 

  18. Dhawan N, Bodukam VK, Thakur K, Singh A, Jenkins D, Bahl J (2015) Idiopathic bilateral adrenal hemorrhage in a 63-year-old male: a case report and review of the literature. Case Rep Urol: doi:10.1155/2015/503638

    PubMed  PubMed Central  Google Scholar 

  19. Oelkers W (1996) Adrenal insufficiency. N Engl J Med 335:1206–1212

    Article  CAS  PubMed  Google Scholar 

  20. Ruffatti AA, Salvan E, Del Ross T et al (2014) Treatment strategies and pregnancy outcomes in antiphospholipid syndrome patients with thrombosis and triple antiphospholipid positivity. A european multicentre retrospective study. Thromb Haemost 112(4):727–735. doi:10.1160/TH14-03-0191

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, 453 alharam st., Giza, Egypt

    A. A. Shahin, S. M. El Desouky & D. E. Megahed

  2. Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    M. Y. Awadallah

Authors
  1. A. A. Shahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. M. El Desouky
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Y. Awadallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. E. Megahed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. A. Shahin.

Ethics declarations

Conflict of interest

A. A. Shahin, S. M. El Desouky, M. Y. Awadallah, and D. E. Megahed state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

Additional information

Redaktion

U. Müller-Ladner, Bad Nauheim

U. Lange, Bad Nauheim

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shahin, A.A., El Desouky, S.M., Awadallah, M.Y. et al. Adrenal gland abnormalities detected by magnetic resonance imaging in patients with antiphospholipid syndrome. Z Rheumatol 76, 170–175 (2017). https://doi.org/10.1007/s00393-016-0107-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-016-0107-1

Keywords

Schlüsselwörter

Search

Navigation