Unilateral adrenal infarction in pregnancy

Green, Paul Ann D.; Ngai, Ivan; Lee, Tony T.; Garry, David

doi:10.1136/bcr-2013-009997

Cited by 25 publications

(27 citation statements)

References 13 publications

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“…While bilateral adrenal infarction may present with primary adrenal insufficiency, 1 rare cases of unilateral adrenal infarction during pregnancy have been reported to present with acute severe upper abdominal pain, 2 which may mimic a wide range of other diagnoses. Where preliminary blood investigations and abdominal sonography are unremarkable, the unexplained nature and severity should prompt further radiological investigation, especially in the known presence of a hypercoagulable state.…”

Section: Discussionmentioning

confidence: 99%

“… 4 While pregnancy itself is a thrombogenic state, other reported thrombophilic causes in this condition include antiphospholipid syndrome, essential thrombocythemia, and methylenetetrahydrofolate reductase C677T gene mutation. 2 , 4 …”

Section: Discussionmentioning

confidence: 99%

“… 1 Unilateral adrenal infarction, with preservation of contralateral adrenal function, may present solely as an acute abdomen during pregnancy, and it may be especially challenging to arrive at a confident diagnosis. This latter condition is extremely rare, and although the pregnant state itself may constitute a thrombogenic factor, cases in association with a hypercoagulable state such as methylene tetra hydro folate reductase C677T gene mutation 2 and essential thrombocythemia 3 have been reported. Elevated factor VIII has also been observed as a cause of thrombogenesis in association with unilateral adrenal infarction in pregnancy.…”

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confidence: 99%

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Unilateral adrenal infarction in pregnancy secondary to elevated factor VIII

Aljenaee

Ali

Cheah

et al. 2017

SMJ

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Adrenal infarction in pregnancy is an extremely rare event. We report a case of a 29-year-old pregnant woman at the twenty-fourth week of gestation that presented with an acute episode of severe localized right upper quadrant pain. Her preliminary blood investigations and abdominal ultrasonography were essentially unremarkable. A diagnosis of right adrenal infarction was subsequently established on the basis of a non-enhanced swollen right adrenal gland on CT scanning of the abdomen with contrast, consistent with the clinical presentation. She was treated with subcutaneous low molecular weight heparin (LMWH) until 2 weeks postpartum. A thrombophilia screen post-partum revealed a significantly elevated factor VIII level and a hypercoagulable state that justified prolonged anticoagulation. This case highlights the importance of a high index of suspicion for adrenal infarction in pregnancy on the clinical grounds of otherwise unexplained acute abdominal pain accompanied by suggestive radiological findings, especially in the presence of thrombophilia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Unilateral adrenal infarction in pregnancy secondary to elevated factor VIII

Aljenaee

Ali

Cheah

et al. 2017

SMJ

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“…Adrenal gland infarction is usually haemorrhagic and bilateral 1. Unilateral adrenal gland infarction in pregnancy is extremely rare, with eight cases reported in medical literature to date 2–6. Most of these infarcts were associated with an underlying thrombophilic syndrome, like antiphospholipid syndrome, Factor VIII abnormality4 or methylenetetrahydrofolatereductase gene mutation 2…”

Section: Introductionmentioning

confidence: 99%

Cryptogenic adrenal infarction: a rare case of unilateral adrenal infarction in a pregnant woman

Agarwal¹,

Soe

2019

BMJ Case Rep

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Adrenal infarction is a rare event, especially in pregnancy. The diagnosis is challenging because patients present with acute abdomen and initial workup are usually unrevealing. We present a case of unilateral adrenal infarction in a pregnant young woman without any other causes of thrombophilia, who presented with acute abdominal pain and an unremarkable initial workup. MRI and contrast-enhanced CT scan revealed a non-haemorrhagic infarct of the right adrenal gland. Our case highlights the importance of considering this rare diagnosis in the differential for a pregnant woman with acute abdomen without any obvious surgical cause.

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“…Moreover, adrenal lesions in autoimmune adrenalitis, or Addison’s disease, are typically bilateral, and to the best of our knowledge, no cases of unilateral adrenal lesions caused by an autoimmune process have been reported. In general, most cases of adrenal infarction are accompanied by hemorrhage and bilateral lesions versus unilateral lesions [ 6 ]. In some cases, the infarction has been suggested as a sign of antiphospholipid syndrome, essential thrombocytosis, or polycythemia vera [ 7 – 9 ].…”

Section: Discussionmentioning

confidence: 99%

The first case of thrombocytopenia, anasarca, fever, renal impairment or reticulin fibrosis, and organomegaly (TAFRO) syndrome with unilateral adrenal necrosis: a case report

et al. 2018

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BackgroundTAFRO syndrome, which was first reported in 2010 in Japan, is a relatively rare disease characterized by thrombocytopenia, anasarca, fever, renal impairment, reticulin fibrosis, and organomegaly. Although this disease is considered similar to multicentric Castleman disease, some of the clinical features, such as thrombocytopenia, are different from typical cases of multicentric Castleman disease. In addition, the etiology of TAFRO syndrome remains unknown and controversial. There have only been a few cases of TAFRO syndrome complicated with adrenal gland lesions, and all of them have had hemorrhagic involvement.Case presentationThis report describes the case of a 46-year-old Asian man who presented with fever, epigastric pain, and back pain for 1 month. A computed tomographic scan revealed ascites, mild lymphadenopathy, and left adrenal necrosis without hemorrhage. A blood test showed thrombocytopenia, anemia, and elevated C-reactive protein, alkaline phosphatase, and creatinine levels. Based on the edema, severe thrombocytopenia, fever, reticulin myelofibrosis shown by bone marrow biopsy, mild lymphadenopathy, and progressive renal insufficiency, we diagnosed this patient as having TAFRO syndrome. He was successfully treated by immediate administration of glucocorticoids and tocilizumab.ConclusionsThere have been no previous reports of a case of TAFRO syndrome complicated with adrenal necrosis. Because the biopsy of the left adrenal gland revealed necrosis without any evidence of hemorrhage, we concluded that the unilateral adrenal necrosis in this case was caused by either ischemia from infarction or organomegaly itself under severe hypercytokinemia. This unusual clinical course is useful for further analysis of the etiology of TAFRO syndrome.

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Unilateral adrenal infarction in pregnancy

Cited by 25 publications

References 13 publications

Unilateral adrenal infarction in pregnancy secondary to elevated factor VIII

Unilateral adrenal infarction in pregnancy secondary to elevated factor VIII

Cryptogenic adrenal infarction: a rare case of unilateral adrenal infarction in a pregnant woman

The first case of thrombocytopenia, anasarca, fever, renal impairment or reticulin fibrosis, and organomegaly (TAFRO) syndrome with unilateral adrenal necrosis: a case report

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