Myelofibrosis and Antiphospholipid Syndrome Presenting With Adrenal Insufficiency Due to Bilateral Adrenal Hemorrhage: A Case Series

Adrenal hemorrhage is rare but appears to occur more frequently in patients with underlying hematological conditions. We report two recent patients with underlying hematological disorders who presented with adrenal insufficiency due to bilateral adrenal hemorrhage. The first case is a 59-year-old woman known to have myelofibrosis. This patient was being treated with warfarin for left leg deep vein thrombosis which developed after splenectomy. She was admitted to hospital with vomiting and abdominal pain. The second case is an 84-year-old male patient with antiphospholipid syndrome and diabetes mellitus who was treated with warfarin and insulin. He was admitted with sudden onset of nausea, hypotension and recurrent hypoglycemia despite cessation of insulin therapy. In both cases, bilateral enlarged adrenal glands consistent with hemorrhage were detected resulting in adrenal insufficiency. It is important that Hematologists and Endocrinologists alike should recognise symptoms of adrenal insufficiency in patients with hematological disorders, particularly those being treated with antiplatelet medications or anticoagulants.