Acute Unilateral Nonhemorrhagic Adrenal Infarction in Pregnancy

Warda, Firas; Soule, Erik; Gopireddy, Dheeraj Reddy; Gandhi, Gunjan Y.

doi:10.1016/j.aace.2020.12.015

Cited by 4 publications

(6 citation statements)

References 5 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%

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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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“…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%

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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“…The right adrenal gland was more commonly affected. Only two previous cases of unilateral NHAI in pregnancy leading to AI were noted ( 20 , 21 ). The left adrenal gland was involved in both cases, similar to our patient.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to our patient, she did not develop adrenal crisis and only required oral hydrocortisone replacement. The second patient was diagnosed with AI based on a cosyntropin stimulation test that showed a mid-normal ACTH level and peak cortisol of 11 µg/dL ( 21 ). That patient stopped the hydrocortisone during pregnancy but went on to have a spontaneous vaginal delivery at 39 weeks and was given stress dose IV hydrocortisone during labor.…”

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

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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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Acute Unilateral Nonhemorrhagic Adrenal Infarction in Pregnancy

Cited by 4 publications

References 5 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 Non-Hemorrhagic Adrenal Infarction in Pregnancy: Case Series and Literature Review

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

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