{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T10:54:25Z","timestamp":1762080865660,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T00:00:00Z","timestamp":1671494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical University of Silesia","award":["PCN-CBN-640-2-1-615\/22"],"award-info":[{"award-number":["PCN-CBN-640-2-1-615\/22"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>The article presents a male patient with adrenocortical insufficiency in the course of antiphospholipid syndrome (APS). It also describes recurrent exacerbations of his clinical status, characteristic of microangiopathic antiphospholipid syndrome (MAPS) which had been misdiagnosed as a disseminated intravascular coagulopathy (DIC) syndrome due to sepsis with multi-organ failure, including heart, kidneys, and liver. Issues related to pathogenesis, clinical symptoms, differential diagnosis, and treatment of APS in the context of presently distinguished subtypes of this syndrome have been addressed. The role of vascular endothelial cell activation and the influence of coagulation patterns on the development of APS continuum clinical symptoms have also been mentioned. In addition, this paper highlights that the diagnosis of APS should be considered in patients with adrenal insufficiency and abdominal pain, even without any prior history of thromboembolic diseases, as well as in the course of DIC, especially without predisposing factors.<\/jats:p>","DOI":"10.3390\/medicina59010004","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T02:31:33Z","timestamp":1671589893000},"page":"4","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Addison\u2019s Disease in the Course of Recurrent Microangiopathic Antiphospholipid Syndrome\u2014A Clinical Presentation and Review of the Literature"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5287-2551","authenticated-orcid":false,"given":"Ma\u0142gorzata","family":"Grabarczyk","sequence":"first","affiliation":[{"name":"Student Scientific Society at the Department of Internal Medicine, Autoimmune and Metabolic Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Gorczyca","sequence":"additional","affiliation":[{"name":"Student Scientific Society at the Department of Internal Medicine, Autoimmune and Metabolic Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3723-3591","authenticated-orcid":false,"given":"Pawe\u0142","family":"Cie\u015blik","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Autoimmune and Metabolic Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoni","family":"Hrycek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Autoimmune and Metabolic Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3289-1050","authenticated-orcid":false,"given":"Micha\u0142","family":"Holecki","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Autoimmune and Metabolic Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/j.1538-7836.2006.01753.x","article-title":"International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)","volume":"4","author":"Miyakis","year":"2006","journal-title":"J. Thromb. Haemost."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"726820","DOI":"10.3389\/fimmu.2021.726820","article-title":"Antiphospholipid Antibody Assays in 2021: Looking for a Predictive Value in Addition to a Diagnostic One","volume":"12","author":"Meroni","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1111\/joim.13022","article-title":"The antiphospholipid syndrome\u2014Often overlooked cause of vascular occlusions?","volume":"287","author":"Svenungsson","year":"2020","journal-title":"J. Intern. Med."},{"key":"ref_4","first-page":"710365","article-title":"Vascular Endothelial Cell Function in Catastrophic Antiphospholipid Syndrome: A Case Report and Review of the Literature","volume":"2013","author":"Routy","year":"2013","journal-title":"Case Rep. Hematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s11420-008-9103-6","article-title":"Catastrophic Antiphospholipid Syndrome Triggered by Sepsis","volume":"5","author":"Kim","year":"2009","journal-title":"HSS J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s12016-008-8104-z","article-title":"Microthrombotic\/microangiopathic manifestations of the antiphospholipid syndrome","volume":"36","author":"Praprotnik","year":"2009","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.hoc.2007.10.007","article-title":"The Clinical Spectrum of Antiphospholipid Syndrome","volume":"22","author":"Baker","year":"2008","journal-title":"Hematol. Oncol. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"355","DOI":"10.2217\/17460816.1.3.355","article-title":"Thrombotic microangiopathic antiphospholipid syndromes: A continuum of conditions","volume":"1","author":"Asherson","year":"2006","journal-title":"Future Rheumatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1136\/ard.2006.067033","article-title":"Is there a microangiopathic antiphospholipid syndrome","volume":"66","author":"Asherson","year":"2007","journal-title":"Ann. Rheum. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.autrev.2006.06.008","article-title":"New subsets of the antiphospholipid syndrome in 2006: \u201cPRE-APS\u201d (probable APS) and microangiopathic antiphospholipid syndromes (\u201cMAPS\u201d)","volume":"6","author":"Asherson","year":"2006","journal-title":"Autoimmun. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.autrev.2007.11.009","article-title":"Microvascular and microangiopathic antiphospholipid associated syndromes (\u201cMAPS\u201d): Semantic or antisemantic","volume":"7","author":"Asherson","year":"2008","journal-title":"Autoimmun. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1093\/rheumatology\/kem158","article-title":"The abdominal manifestations of the antiphospholipid syndrome","volume":"46","author":"Uthman","year":"2007","journal-title":"Rheumatology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1007\/s40618-019-01079-6","article-title":"Epidemiology, pathogenesis, and diagnosis of Addison\u2019s disease in adults","volume":"42","author":"Betterle","year":"2019","journal-title":"J. Endocrinol. Investig."},{"key":"ref_14","unstructured":"Munir, S., Quintanilla Rodriguez, B.S., and Waseem, M. (2022). Addison Disease. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_15","first-page":"76","article-title":"Definitive bilateral adrenal failure in antiphospholipid syndrome","volume":"37","author":"Caetano","year":"2012","journal-title":"Acta Reum. Port."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1191\/0961203303lu404oa","article-title":"Adrenal involvement in the antiphospholipid syndrome","volume":"12","author":"Espinosa","year":"2003","journal-title":"Lupus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"049","DOI":"10.1055\/s-0030-1270071","article-title":"Antiphospholipid Syndrome: Endocrinologic Manifestations and Organ Involvement","volume":"37","author":"Mehdi","year":"2011","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"300060520903659","DOI":"10.1177\/0300060520903659","article-title":"Adrenal failure and antiphospholipid syndrome","volume":"48","author":"Jensterle","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.autrev.2018.06.014","article-title":"Adrenal insufficiency in systematic lupus erythematosus (SLE) and antiphospholipid syndrome (APS): A systematic review","volume":"18","author":"Lee","year":"2019","journal-title":"Autoimmun. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1111\/jth.15082","article-title":"Antiphospholipid syndrome: Complement activation, complement gene mutations, and therapeutic implications","volume":"19","author":"Chaturvedi","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1177\/0961203320950477","article-title":"Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) implies a more severe disease with more damage accrual and higher mortality","volume":"29","author":"Alonso","year":"2020","journal-title":"Lupus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1136\/ard.51.2.147","article-title":"The antiphospholipid syndrome: A syndrome in evolution","volume":"51","author":"Asherson","year":"1992","journal-title":"Ann. Rheum. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1191\/0961203305lu2202oa","article-title":"Cardiac involvement in the antiphospholipid syndrome","volume":"14","author":"Tenedios","year":"2005","journal-title":"Lupus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"915309","DOI":"10.1155\/2013\/915309","article-title":"Catastrophic Antiphospholipid Syndrome with Severe Acute Thrombotic Microangiopathy and Hemorrhagic Complications","volume":"2013","author":"Vieregge","year":"2013","journal-title":"Case Rep. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2169\/internalmedicine.52.8970","article-title":"Disseminated Intravascular Coagulation in the Presence of Antiphospholipid Antibodies: The Differential Diagnosis from Catastrophic or Microangiopathic Antiphospholipid Syndrome","volume":"52","author":"Yasuda","year":"2013","journal-title":"Intern. 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