 |
Case Report
Non-hemorrhagic unilateral adrenal infarct in pregnancy
1 The Ohio State University Wexner Medical Center, USA
Address correspondence to:
Yueyang F. Fei
The Ohio State University Wexner Medical Center, Department of Obstetrics and Gynecology, 395 W. 12th Ave, Columbus, OH 43210,
USA
Message to Corresponding Author
Article ID: 100044Z08YF2019
Access full text article on other devices
Access PDF of article on other devices
How to cite this article
Fei YF, Gonzalez-Brown V, Rood K, Buschur E. Non-hemorrhagic unilateral adrenal infarct in pregnancy. J Case Rep Images Obstet Gynecol 2019;5:100044Z08YF2019.ABSTRACT
Introduction: Adrenal infarct is a rare cause of abdominal pain, which is especially true in pregnancy. The symptoms and signs of insufficiency will depend on the amount of adrenal function lost. The adrenal gland has a unique vasculature that may facilitate infarction in a hypercoagulable state. Currently only limited case reports and small series describing evaluation and management of adrenal infarct are found in the literature. Unilateral adrenal infarct is a rare finding in pregnancy but an important diagnosis to consider to prevent incorrect management and worsening bilateral infarction.
Case Report: A 21-year-old G2P0010 presented at 29 4/7 weeks with sudden onset right upper quadrant and flank pain, fever, nausea, and vomiting. The patient was initially empirically treated for complicated urinary tract infection/pyelonephritis despite no clear laboratory evidence of infection. There was no evidence of adrenal insufficiency with the exception of fasting ketosis. The remainder of evaluation was unremarkable including ultrasounds and X-rays. Unilateral adrenal infarct was diagnosed on contrast-enhanced computed tomography with no associated hemorrhage. Thrombophilia assessment was notable for methylenetetrahydrofolate reductase (MTHFR) gene heterozygous and prothrombin G20210A gene heterozygous. She was treated with subcutaneous low molecular weight heparin (LMWH) through delivery and six weeks post-partum.
Conclusion: Unilateral non-hemorrhagic adrenal infarction may be an underdiagnosed cause of acute abdominal pain during pregnancy.
Keywords: Adrenal infarct, Pregnancy, Thrombophilia
SUPPORTING INFORMATION
Author Contributions
Yueyang F. Fei - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Veronica Gonzalez-Brown - Substantial contributions to conception and design, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Kara Rood - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Elizabeth Buschur - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Yueyang F. Fei et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
