Acute spontaneous non-hemorrhagic adrenal infarction in pregnancy: case-report and literature review

Ornaghi, Sara; Fernicola, Federica; Marelli, Elisabetta; Perotti, Mario; Di Gennaro, Filiberto; Cameroni, Irene; Mariani, Eloisa M.; Pincelli, Angela I.; Colciago, Elisabetta; Cetin, Irene; Vergani, Patrizia

doi:10.1080/09513590.2023.2234492

Cited by 2 publications

(3 citation statements)

References 43 publications

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“…In one study, urinary calculi was diagnosed in 13 out of 20 pregnant women who underwent CT of the abdomen and pelvis for the evaluation of acute, refractory flank pain (18). Unilateral NHAI typically does not lead to AI if the contralateral adrenal gland is healthy (19). The possible underlying pathophysiologic mechanism for the development of AI in our patient is that the healthy adrenal gland could not keep up with the demand for increased cortisol production in pregnancy.…”

Section: Discussionmentioning

confidence: 76%

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New-onset primary adrenal insufficiency in pregnancy associated with a unilateral adrenal infarction: a case report

Menon,

Edem,

Maradana

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary New-onset primary adrenal insufficiency is rare in pregnancy. The symptoms of adrenal insufficiency such as nausea, vomiting and dizziness may be attributed to the pregnancy itself, which can lead to a delay in the diagnosis. The presence of hypotension, hypoglycemia or hyperkalemia should raise the suspicion for adrenal insufficiency. We report the case of a 25-year-old woman who presented with tachycardia, left flank pain and vomiting at 36 weeks’ gestation. She was found to have primary adrenal insufficiency and started on hydrocortisone and fludrocortisone with resolution of the vomiting and tachycardia. MRI of the abdomen revealed an acute nonhemorrhagic infarct of the left adrenal gland. The contralateral adrenal gland was normal. Autoimmune and infectious etiologies of primary adrenal insufficiency were ruled out and the adrenal insufficiency was attributed to the unilateral adrenal infarction. Adrenal insufficiency persisted after delivery and then resolved at approximately 16 months post partum. This case highlights the need to test women with unilateral adrenal infarction in pregnancy for the presence of primary adrenal insufficiency. Learning points Adrenal insufficiency should be considered when a pregnant woman develops nausea, vomiting and dizziness in association with hypotension or hypoglycemia. Hypovolemic hyponatremia related to vomiting can occur in pregnancy, but the failure to correct hyponatremia despite adequate IV hydration should raise the suspicion for adrenal insufficiency. Adrenal infarction should be in the differential diagnosis for unilateral flank pain in pregnancy. Other common etiologies for flank pain in pregnancy include nephrolithiasis, pyelonephritis and acute cholecystitis. Unilateral adrenal infarction in pregnancy can lead to the development of primary adrenal insufficiency. Following delivery, these patients need to be monitored for the resolution of the adrenal insufficiency.

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Section: Discussionmentioning

confidence: 76%

“…Unilateral NHAI typically does not lead to AI if the contralateral adrenal gland is healthy ( 19 ). The possible underlying pathophysiologic mechanism for the development of AI in our patient is that the healthy adrenal gland could not keep up with the demand for increased cortisol production in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

New-onset primary adrenal insufficiency in pregnancy associated with a unilateral adrenal infarction: a case report

Menon,

Edem,

Maradana

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

View full text Add to dashboard Cite

show abstract

“…Acute adrenal infarction (AI) is very rare and easily overlooked, especially in patients without adrenal insufficiency, which is diagnosed mainly by imaging. AI was relatively common in antiphospholipid antibody syndrome (APS), [3][4][5][6] pregnancy, [7] and also existed in Crohn disease, [8] COVID-19, [9] myelodysplastic/myeloproliferative neoplasm, [10] substance use (e.g., methamphetamine), [11] heparininduced thrombocytopenia [12] and aortic dissection, [2] etc. However a large portion of individuals originally manifested signs of AI before the primary disease was identified.…”

Section: Introductionmentioning

confidence: 99%

Acute spontaneous non-hemorrhagic adrenal infarction with systemic lupus erythematosus and antiphospholipid antibody syndrome: A case report

Liang,

Qiu,

et al. 2024

Medicine

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Rationale: Adrenal infarction (AI) is a rare type of adrenal damage, which is relatively common in systemic lupus erythematosus, antiphospholipid antibody syndrome (APS) and pregnancy. The diagnosis of AI is mainly by computed tomography (CT) and magnetic resonance imaging, but is easily confused with other adrenal disease. Hence, this report details a condition of AI with systemic lupus erythematosus, APS and made a differential diagnosis from imaging. Patient concerns: We report a case of a 55-year-old woman with pain in her fossa axillaries and inguinal regions. Then CT scan disclosed bilateral adrenal diseases, and the patient was diagnosed with systemic lupus erythematosus, APS and AI after additional autoimmune examinations. Diagnoses: The patient was diagnosed as systemic lupus erythematosus with lupus nephritis, hematological damage and oromeningitis, APS, AI and secondary blood coagulation disorders. Interventions: The patient was treated with methylprednisolone, hydroxychloroquine and low molecular heparin. Outcomes: The patient relieves and remains well 1 year after treatment. Lessons subsections: AI can be divided hemorrhagic and non-hemorrhagic, with bilateral lesions more common. In our case, the AI was bilateral, partially involved and non-hemorrhagic, and the “cutoff sign” was first put forward in CT, which might assist the diagnosis.

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Acute spontaneous non-hemorrhagic adrenal infarction in pregnancy: case-report and literature review

Cited by 2 publications

References 43 publications

New-onset primary adrenal insufficiency in pregnancy associated with a unilateral adrenal infarction: a case report

New-onset primary adrenal insufficiency in pregnancy associated with a unilateral adrenal infarction: a case report

Acute spontaneous non-hemorrhagic adrenal infarction with systemic lupus erythematosus and antiphospholipid antibody syndrome: A case report

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