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

• Published in: Gynecological endocrinology Vol. 35; no. 11; pp. 941 - 944
• Main Authors: Chasseloup, F, Bourcigaux, N, Christin-Maitre, S
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02.11.2019
• Subjects: Abdominal Pain - etiology; Adrenal Glands - blood supply; Adrenal Glands - diagnostic imaging; Adult; Endocrinology and metabolism; Female; Human health and pathology; Humans; Infarction - complications; Infarction - diagnostic imaging; Life Sciences; Pregnancy; Pregnancy Complications - diagnostic imaging; Pregnancy Complications - etiology; Tomography, X-Ray Computed; Adrenal infarction; nonhemorrhagic adrenal infarction; adrenal thrombosis; abdominal pain; pregnancy
• ISSN: 0951-3590; 1473-0766
• DOI: 10.1080/09513590.2019.1622088

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.