Ischémie aiguë unilatérale de la glande surrénale en cours du 3e trimestre de grossesse : à propos de deux cas

Hoen, Nathalie; Ziane, G.; Grangé, C.; Raudrant, D.; Dupuis, Olivier

doi:10.1016/j.gyobfe.2011.03.005

Cited by 7 publications

(1 citation statement)

References 5 publications

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“…It is interesting to highlight that from the nine cases in the literature, as well as the case we report, eight involved the right adrenal gland. The main involvement of the right adrenal could be explained by its anatomical location with respect to that of the vena cava, taking into account that the return of venous blood can be impaired by the gravid uterus leading to adrenal blood stasis (12,13). The pathogenesis of adrenal infarction has been best described by Fox in his seminal paper in the Journal of Pathology (9).…”

Section: Discussionmentioning

confidence: 99%

Unilateral Adrenal Infarction in Pregnancy: A Case Report

Hajjaji¹,

Jemaa²,

Mnejja³

et al. 2022

Gynecol Obstet Reprod Med

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Adrenal infarction is usually associated with bilateral adrenal hemorrhage in the setting of antiphospholipid syndrome or hemodynamic variation. Few cases of unilateral non-hemorrhagic adrenal infarction have been described in the literature. Here, we report a case occurring during pregnancy. A 27-year-old woman was infected by coronavirus four months ago and presented at 35 weeks of gestation with sudden-onset right abdominal pain without contractions. Unilateral adrenal infarction was diagnosed following computed tomography. It showed an enlarged right adrenal, without hyperenhancement. The patient’s adrenal hormonal function was normal. Accurate diagnosis of non-hemorrhagic adrenal infarction remains difficult as its clinical presentation is not specific. It can only be performed with adrenal imaging. Magnetic resonance imaging shows diffuse enlargement of one or both adrenals and edema on T2-weighted images. Anticoagulation therapy may be discussed. Patients should be evaluated between 3 and 6months after the event to assess adrenal size and function. In summary, non-hemorrhagic adrenal infarction during pregnancy is probably underdiagnosed and obstetricians should be aware of this diagnostic difficulty.

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Section: Discussionmentioning

confidence: 99%

Unilateral Adrenal Infarction in Pregnancy: A Case Report

Hajjaji¹,

Jemaa²,

Mnejja³

et al. 2022

Gynecol Obstet Reprod Med

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Value of the CT “capsular sign” as a potential indicator of acute adrenal ischemia

et al. 2015

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Acute adrenal ischemia represents a rare cause of adrenal insufficiency which should be promptly diagnosed in order to preserve adrenal vitality and function. Our study aims to retrospectively evaluate the diagnostic accuracy of the CT capsular sign as an indicator of adrenal ischemia and its association with vascular involvement. Between January 2013 and January 2014, 69 consecutive patients (47 men, 22 women; mean age 46; range 22-67) with suspected adrenal insufficiency based on clinical and biochemical data underwent 320-row CT examination in our Emergency Department. Written informed consent was obtained for the CT examinations, and the institutional review board approval was obtained for our retrospective study. CT multi-planar images were retrospectively and independently analyzed by two radiologists searching for the patency of adrenal vessels, enlarged adrenals, the presence of the "capsular sign" represented by a peripheral subtle hyperdense line around a hypodense enlarged adrenal, and the presence of any periadrenal inflammatory changes. All CT findings were then compared with the surgical findings (n = 5), follow-up examinations (n = 20), or autopsy (n = 4). Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV), and negative predictive value (NPV) were calculated for the "capsular sign" and were further evaluated by ROC analysis. Acute adrenal ischemia occurred in 29/69 patients (42 %), unilateral in 20, and bilateral in 9. Forty of sixty-nine patients (58 %) had no evidence of adrenal disease on CT. Thrombosis of the main adrenal vein was found in 20/29 (69 %) and non-venous ischemia in 9/29 (31 %). The capsular sign was found in 24/29 patients (83 %). Sensitivity, specificity, DA, PPV, and NPV values of 83, 100, 93, 100, and 89 %, respectively, were obtained. The capsular sign represents a CT indicator of acute adrenal ischemia, with a specificity of 100 % and leading to a prompt diagnosis in the early phase of the disease.

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