Precocious ischemia preceding bilateral adrenal hemorrhage: A case report

Galatola, Roberta; Gambardella, Michele; Mollica, Carmine; Calogero, Armando; Magliulo, Mario; Romeo, Valeria; Maurea, Simone; Mainenti, Pier Paolo

doi:10.1016/j.radcr.2020.03.013

Cited by 4 publications

(8 citation statements)

References 10 publications

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“…Based on our observations and other similar cases, Table 1 shows the expected intensity of normal, infarcted, and hemorrhagic glands on typical MR imaging sequences [1,7,8,10,12,14,[17][18][19].…”

Section: Discussionsupporting

confidence: 62%

“…The infarcted adrenal gland measures at 874 units, indicating greater restricted diffusion due to infarcted parenchyma. The findings of edema, swelling, and greater restricted diffusion were considered diagnostic of right adrenal gland infarct [2,8,[9][10][11][12][13][14][15][16][17][18][19]. Our patient's hospital course followed with a complete hypercoagulability panel, hematology/oncology and endocrinology consultations.…”

Section: Case Presentationmentioning

confidence: 92%

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Diffusion Weighted Imaging in Unilateral Adrenal Infarction: A Case of Colicky Right Upper Quadrant Pain in a Pregnant Female

Padilla¹,

Way²,

Soule³

et al. 2021

Cureus

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Diffusion weighted imaging (DWI) is a magnetic resonance imaging (MRI) non-contrast sequence that can indicate tissue ischemia or infarction. Adrenal infarct may present similarly to biliary or gallbladder pathologies, and the differential diagnosis during emergency work-up can be narrowed utilizing DWI sequences. In this paper, we describe the usefulness of DWI for urgent diagnosis in a case of nonhemorrhagic adrenal infarct of a pregnant female presenting with right upper quadrant pain. Although uncommon, adrenal infarct may occur in patients with hypercoagulability and localizing pain that is unexplained by other imaging modalities. We outline the imaging features of DWI in evaluating adrenal infarct as a safe and time effective application for patients with contraindications to imaging with ionizing radiation.

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Section: Discussionsupporting

confidence: 62%

Section: Case Presentationmentioning

confidence: 92%

Diffusion Weighted Imaging in Unilateral Adrenal Infarction: A Case of Colicky Right Upper Quadrant Pain in a Pregnant Female

Padilla¹,

Way²,

Soule³

et al. 2021

Cureus

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“…They end abruptly [ 21 ] and venous drainage is provided by a single vein. The abrupt flow changes in the plexus creates hemodynamic turbulence, leading to platelet aggregation and adrenal infarction [ 4 , 22 ], especially in thrombophilia or a hypercoagulable state. These anatomic characteristics are often described as a “vascular dam” [ 3 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Heparin, for example, was administered in cases of adrenal infarction with APS [ 2 , 3 ] or pregnancy [ 5 , 7 , 8 ], and warfarin was administered in a case of COVID-19 [ 11 ]. Attention should be paid to the consequent adrenal hemorrhage [ 3 , 22 ] once anticoagulation therapy is initiated. On the other hand, aspirin was used to prevent thrombosis in cases of MPN [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Recurrent bilateral adrenal infarction with myelodysplastic/myeloproliferative neoplasm-unclassifiable (MDS/MPN-U): a case report

Hoshino,

Manaka,

Sato

et al. 2023

BMC Endocr Disord

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Background Bilateral adrenal infarction is rare and only a small number of cases have been reported so far. Adrenal infarction is usually caused by thrombophilia or a hypercoagulable state, such as antiphospholipid antibody syndrome, pregnancy, and coronavirus disease 2019. However, adrenal infarction with myelodysplastic/myeloproliferative neoplasm (MDS/MPN) has not been reported. Case presentation An 81-year-old man with a sudden severe bilateral backache presented to our hospital. Contrast-enhanced computed tomography (CT) led to the diagnosis of bilateral adrenal infarction. Previously reported causes of adrenal infarction were all excluded and a diagnosis of MDS/MPN-unclassifiable (MDS/MPN-U) was reached, which was considered to be attributed to adrenal infarction. He developed a relapse of bilateral adrenal infarction, and aspirin administration was initiated. Partial primary adrenal insufficiency was suspected as the serum adrenocorticotropic hormone level was persistently high after the second bilateral adrenal infarction. Conclusion This is the first case of bilateral adrenal infarction with MDS/MPN-U encountered. MDS/MPN has the clinical characteristics of MPN. It is reasonable to assume that MDS/MPN-U may have influenced bilateral adrenal infarction development, considering the absence of thrombosis history and a current comorbid hypercoagulable disease. This is also the first case of recurrent bilateral adrenal infarction. It is important to carefully investigate the underlying cause of adrenal infarction once adrenal infarction is diagnosed, as well as to assess adrenocortical function.

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“…In our case, the diagnosis of adrenal hemorrhage was discovered on CT imaging incidentally showing adrenal congestion with evidence of mild hemorrhage. Te difuse thickening of the glands and adrenal enlargement has been reported as a precursor of adrenal hemorrhage [10,[12][13][14]. A high index of suspicion is needed, and any clinical indicators of acute adrenal insufciency should prompt immediate measurement of cortisol and ACTH.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Adrenal Hemorrhage with Mild Hypoadrenalism in a Patient Anticoagulated with Apixaban for Antiphospholipid Syndrome: A Case Report and Literature Review

Tan

Shukla

et al. 2022

Case Reports in Endocrinology

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Background. Adrenal hemorrhage (AH) is a serious endocrine complication of antiphospholipid syndrome (APLS). Case Presentation. We report a 45-year-old man who presented with several deep venous thromboses and was initially treated with apixaban, who later developed bilateral AH. Laboratory findings were consistent with cortisol deficiency yet preserved aldosterone physiology. He was diagnosed with APLS and treated with warfarin. After 8 months of follow-up, he remained on cortisol replacement with no evidence of recovery. We reviewed PubMed/MEDLINE indexed articles from 1950 to 2022 for cases of AH in APLS patients on anticoagulation. Six cases of patients on direct oral anticoagulants (DOACs) were reported. Discussion. The unique vasculature of the adrenal glands creates a “functional vascular dam” in the zona reticularis, which is susceptible to thrombosis in situ and hemorrhage. DOACs may further increase the risk of AH. Conclusion. Depending on the degree of adrenal involvement in AH, patients can present with partial or complete primary adrenal insufficiency. More data are needed to characterize adrenal function after AH, and the safety of DOAC versus warfarin in patients with APLS warrants further studies.

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Precocious ischemia preceding bilateral adrenal hemorrhage: A case report

Cited by 4 publications

References 10 publications

Diffusion Weighted Imaging in Unilateral Adrenal Infarction: A Case of Colicky Right Upper Quadrant Pain in a Pregnant Female

Diffusion Weighted Imaging in Unilateral Adrenal Infarction: A Case of Colicky Right Upper Quadrant Pain in a Pregnant Female

Recurrent bilateral adrenal infarction with myelodysplastic/myeloproliferative neoplasm-unclassifiable (MDS/MPN-U): a case report

Spontaneous Adrenal Hemorrhage with Mild Hypoadrenalism in a Patient Anticoagulated with Apixaban for Antiphospholipid Syndrome: A Case Report and Literature Review

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