Cryptogenic adrenal infarction: a rare case of unilateral adrenal infarction in a pregnant woman

Agarwal, Krishna A.; Soe, Myat Han

doi:10.1136/bcr-2018-228795

Cited by 6 publications

(8 citation statements)

References 10 publications

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“…In our descriptive analysis, we find similarities between our patients and the literature review [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Indeed, the epidemiological data of age, term, gestation and parity are similar.…”

Section: Discussionsupporting

confidence: 68%

“…We wanted to compare our population to the literature, by carrying out a systematic review of articles published over the same 2012 to 2022 period. That way, a systematic twenty-four case review, spread over fifteen articles [ 1 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ], was made. Table 2 summarizes the clinical, biological, radiological and etiological presentations of these patients.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Adrenal Gland Necrosis in Pregnancy: How to Manage? Case Series at Nantes University Hospital and Literature Review

Guyon,

Degez,

Artifoni

et al. 2023

JCM

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Adrenal necrosis is a rare but serious cause of abdominal pain of thrombotic origin during pregnancy. There is often a delay in diagnosis and treatment. The objective was to specify the clinical and paraclinical signs suggestive of adrenal necrosis, making it possible to improve the delay in diagnostic. The secondary objective was to establish a multidisciplinary protocol regarding management. This is a case report of pregnant women with a radiological diagnosis of adrenal gland necrosis. In parallel, we carried out a systematic review in the same period. We studied these patients’ clinical, biological and radiological data. We included eight patients with a computed tomography scan diagnosis of adrenal necrosis and fifteen articles in the literature describing twenty-four cases. All the patients presented with the same symptoms. The treatment was based on curative anticoagulation. The diagnosis of adrenal gland necrosis is worth suggesting in view of the array of sudden morphine-resistant abdominal pain associated with a biological inflammatory syndrome. The diagnosis is based on the computed tomography scan. Three to six months of curative anticoagulation is recommended as well as a thrombophilia and endocrinological assessment to rule out adrenal insufficiency.

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Section: Discussionsupporting

confidence: 68%

Section: Resultsmentioning

confidence: 99%

Adrenal Gland Necrosis in Pregnancy: How to Manage? Case Series at Nantes University Hospital and Literature Review

Guyon,

Degez,

Artifoni

et al. 2023

JCM

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“…Nonhemorrhagic adrenal infarction (NHAI) is a very rare diagnosis with only a few reported cases during pregnancy [1][2][3][4][5][6][7][8][9][10][11]. We have found around nine cases in the literature describing unilateral NHAI during pregnancy [ Adrenal infarction can present with abdominal pain, nausea and vomiting as well as electrolytes disturbances.…”

Section: Discussionmentioning

confidence: 99%

Left Flank Pain During Pregnancy With an Unpredictable Etiology: Think of Nonhemorrhagic Adrenal Infarction

et al. 2021

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Abdominal pain is the most presenting complaint during pregnancy with multiple etiologies. The diagnosis could be unpredictable. We present a case of 36-year-old pregnant woman gravida 10 para 7 abortus 2 at 36 + 5 weeks of gestation presenting twice for an increasing left abdominal pain, not relieved despite analgesics. She was delivered for severe oligohydramnios. After delivery, she was found to have a left adrenal infarction on computed tomography scan. She was found to have two mutations of the gene MTHFR 677CC. Our presented case should remind physicians to consider the presence of thromboembolic state during pregnancy. The diagnosis of adrenal infarction should be among the differentials of an ambiguous flank pain that is resilient to medical therapy. Diagnosis in a pregnant patient can be easily confirmed with MRI, after which anticoagulation should be started and the workup for hypercoagulable state investigated.

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“…Since the first publication of unilateral non-hemorrhagic adrenal infarction (NHAI) diagnosed via MRI [8], further reports have been published [8][9][10][11][12][13]. NHAI during pregnancy needs to be differentiated from an acute bilateral adrenal hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

“…The adrenal perfusion is characterized by a rich arterial supply and drainage by a singular central vein. Pregnancy-associated hypercoagulability and the effect of the expanding uterus on the intra-and retroperitoneal structures may contribute to the development of NHAI [9][10][11][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Unilateral Non-Hemorrhagic Adrenal Infarction in Pregnancy: Case Series and Literature Review

Tschuertz,

Kupczyk,

Poetzsch

et al. 2023

JCM

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To summarize the evidence on non-hemorrhagic adrenal infarction (NHAI) and identify questions arising in diagnosis and management, cases in the PubMed database were merged with our case series. A total of 92 publications were retrieved, 15 of which reported on NHAI during pregnancy. Including the four in our case series, 24 cases have been described so far. Severe, unremitting pain requiring opioid analgesia was the leading symptom, often combined with nausea and vomiting. Laboratory results were non-contributory in most cases. Diagnosis was established via MRI in nine cases (37.5%) and via CT in six (25%); nine patients (37.5%) underwent both investigations. Location was predominantly on the right side (n = 16, 66.7%). In addition to analgesia, anticoagulation with heparin was commenced in 18 cases (75%). When thrombophilia screening was performed, major thrombogenic polymorphisms were detected in six cases (33.3%). One woman developed signs of adrenal insufficiency. The reported perinatal outcome was unremarkable. Unilateral NHAI has emerged as a rare but important cause of severe abdominal pain in pregnancy. The threshold to perform an MRI in pregnant women with characteristic clinical findings should be low. To prevent fetal radiation exposure, diagnostic imaging via CT should be avoided. In addition to symptomatic treatment with opioid analgesia, initiation of anticoagulant treatment should be strongly considered.

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Cryptogenic adrenal infarction: a rare case of unilateral adrenal infarction in a pregnant woman

Cited by 6 publications

References 10 publications

Adrenal Gland Necrosis in Pregnancy: How to Manage? Case Series at Nantes University Hospital and Literature Review

Adrenal Gland Necrosis in Pregnancy: How to Manage? Case Series at Nantes University Hospital and Literature Review

Left Flank Pain During Pregnancy With an Unpredictable Etiology: Think of Nonhemorrhagic Adrenal Infarction

Unilateral Non-Hemorrhagic Adrenal Infarction in Pregnancy: Case Series and Literature Review

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