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

Jerbaka, Myriam; Slaiby, Tracy; Farhat, Zahraa; Diab, Yara Hage; Toufayli, Nawal; Rida, Khaled; Diab, Taghreed

doi:10.2144/fsoa-2021-0022

Cited by 5 publications

(5 citation statements)

References 12 publications

(20 reference statements)

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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%

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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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“…1 There is a paucity of clinical reports describing this clinical entity, with <20 such cases published in literature so far. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 The location of the pain varies from case to case and may occur in the flanks, abdomen, or chest. Recognition of adrenal infarction as a cause of abdominal pain during gestation is challenging due to the obscurity of this diagnosis and the fact that during evaluation of such cases, attention usually turns to the usual culprits, for example, physiological (uterine enlargement/increase volume of amniotic fluid), preterm labor, placental abruption, appendicitis, cholecystitis, and pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

Unilateral adrenal infarction in pregnancy with associated acute hypoadrenalism and subsequent spontaneous biochemical and radiological resolution

Shah

Deshmukh

Akbar

et al. 2022

Clinical Case Reports

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Adrenal infarction is a rare cause of abdominal pain during pregnancy, and if missed, it can result in devastating clinical consequences for the mother and the child. The authors report a case of a young female who presented with severe abdominal pain and nausea. The biochemistry showed raised inflammatory markers and significant lactic acidosis. As the cause of the symptoms was not clear and the patient continued to deteriorate, a contrast‐enhanced CT abdomen and pelvis was done which was suggestive of an acute left adrenal infarction. Subsequently, the patient was confirmed to have biochemical hypoadrenalism and required replacement doses of hydrocortisone until recovery of the adrenal glucocorticoid reserve and anticoagulation for the duration of pregnancy. We discuss the workup including diagnostic imaging, follow‐up, and considerations for future pregnancies in this case.

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“…A total of 92 publications were retrieved, 15 of which reported on NHAI during pregnancy [8][9][10][11][12][13]15,16,[19][20][21][22][23][24][25]. Only case reports and small case series were found.…”

Section: Resultsmentioning

confidence: 99%

“…Figure 1 illustrates the identification, selection and exclusion process of our search. Including our own patients and excluding cases published twice [8,9,19,[23][24][25], 24 cases are described [8,9,[11][12][13]15,16,[19][20][21][22]25]. Symptoms, investigations, management and outcome are listed in Tables 1-3.…”

Section: Resultsmentioning

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

Cited by 5 publications

References 12 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

Unilateral adrenal infarction in pregnancy with associated acute hypoadrenalism and subsequent spontaneous biochemical and radiological resolution

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

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