Acute Unilateral Nonhemorrhagic Adrenal Infarction in Pregnancy

Abstract

Abstract Objective To highlight the imaging findings in a pregnant woman with unilateral adrenal infarction complicating pregnancy. Methods Retrospective chart review to obtain pertinent information including history, physical examination findings, laboratory results, as well as review diagnostic imaging studies. MRI of the abdomen was reviewed and interpreted by the radiology team. Results A 24-year-old woman, 30 weeks pregnant, presented to the emergency room with severe left upper quadrant abdominal pain, radiating to the back, and associated with nausea and vomiting. Physical exam was significant for tenderness to light palpation in the left upper abdominal quadrant with voluntary guarding. Abdominal MRI noted a T2 hypointense left adrenal gland with loss of normal diffusion restriction. A diagnosis of unilateral adrenal infarct was made and patient was started on enoxaparin. Corticosteroids were started after a suboptimal cortisol response to ACTH stimulation. Conclusion Unilateral adrenal infarction is rare with only a few cases reports in the literature. Thrombophilia evaluation is warranted as antiphospholipid syndrome and MTHFR gene mutations have been associated with this condition. MRI is superior to other imaging modalities due to its sensitivity in detecting adrenal infarction and possible hemorrhage, if present. Unfortunately, there are no guidelines on managing such patients. Focus is usually placed on anticoagulation to prevent the infarction of the contralateral adrenal gland, with cautious monitoring as hemorrhagic conversion is possible, as well as screening patients for adrenal insufficiency for prompt supplementation with corticosteroids if needed. Attempting to find the underlying cause is crucial.