Unilateral nonhaemorrhagic adrenal infarction as a cause of abdominal pain during pregnancy

Abstract

Adrenal infarction is usually associated with bilateral adrenal hemorrhage in the setting of antiphospholipid syndrome or hemodynamic variation. Few cases of unilateral nonhemorrhagic adrenal infarction (NHAI) have been described in the literature. Here, we report a case occurring during pregnancy. A 30-year-old woman presented at 32 weeks of gestation with sudden-onset right abdominal pain and contractions. Unilateral adrenal infarction was diagnosed following computed tomography (CT). It showed an enlarged right adrenal, without hyperenhancement. Because of persisting contractions, despite medical care, she delivered a healthy, albeit premature, girl. Abdominal pain decreased right after delivery. Three month later, CT imaging showed atrophy of the right adrenal and a normal left adrenal. The patient’s adrenal hormonal function was normal. Accurate diagnosis of NHAI remains difficult as its clinical presentation is not specific. It can only be performed with adrenal imaging. Magnetic resonance imaging shows diffuse enlargement of one or both adrenals and an edema on T2-weighted images. Anticoagulation therapy may be discussed. Patients should be evaluated between 3 and 6 months after the event to assess adrenal size and function. In summary, NHAI during pregnancy is probably underdiagnosed and obstetricians should be aware of this or diagnostic difficulty.

摘要

在抗磷脂综合征或血流动力学改变的背景下, 肾上腺梗死通常与双侧肾上腺出血有关。文献报道单侧非出血性肾上腺梗死（NHAI）很少。一位30岁女性在怀孕32周时突然出现右腹痛和宫缩。计算机断层扫描（CT）诊断单侧肾上腺梗死。显示右肾上腺肿大, 无过度强化。由于持续的宫缩, 尽管有医疗护理, 她还是生下了一个健康的, 虽然还不成熟的女孩。分娩后腹痛立即减轻。三个月后, CT显示右肾上腺萎缩, 左肾上腺正常。患者的肾上腺激素功能正常。由于NHAI的临床表现不明确, 因此准确诊断NHAI仍有困难。它只能用肾上腺成像来进行。磁共振成像显示一个或两个肾上腺弥漫性增大, T2加权像有水肿。可讨论抗凝治疗。患者应在事件发生后3至6个月内进行评估, 以评估肾上腺的大小和功能。总之, 怀孕期间的NHAI可能诊断不足, 产科医生应该意识到这一点或诊断困难。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Adrenal infarction
• adrenal thrombosis
• pregnancy
• nonhemorrhagic adrenal infarction
• abdominal pain

Disclosure statement

No potential conflict of interest was reported by the authors.