Adrenal Infarction in Pregnancy Secondary to Elevated Plasma Factor VIII Activity.
Adrenal Infarction in Pregnancy Secondary to Elevated Plasma Factor VIII Activity.
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DOI：
10.7759/cureus.19491
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Jacob R
中科院分区：
文献类型：
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作者：
Mathew R;Ali A;Sanders K;Flint A;Lamsal S;DeReus H;Cueno M;Jacob R
单侧肾上腺梗死是妊娠期急性腹痛 (AAP) 的罕见原因。它的表现是非特异性的，需要高度怀疑和低阈值才能获得放射线成像以进行诊断。评估 AAP 具有挑战性，因为放射诊断成像通常与发育中胎儿的辐射暴露有关。我们描述了一名 24 岁孕妇的病例，她出现严重的急性腹痛。患者的疼痛对静脉镇痛药无效，超声检查也无法得出结论。由于发育中的胎儿存在辐射暴露风险，因此未进行计算机断层扫描 (CT) 扫描。由于持续疼痛并怀疑有其他严重病因，完成了磁共振成像（MRI）检查，患者被诊断为急性单侧肾上腺梗死。在本病例报告中，单侧肾上腺梗塞可能继发于血浆因子 VIII 水平升高。即使怀孕期间因子 VIII 水平在生理上升高，但水平超过 150 IU/dL 也会导致静脉血栓形成的风险增加五倍以上。一旦排除出血，患者应开始接受抗凝治疗，以防止肾上腺梗塞或对侧肾上腺梗塞的进展。怀孕期间及时识别和治疗急性肾上腺梗死对于预防母亲和胎儿的不良后果至关重要。
Unilateral adrenal infarction is a rare cause of acute abdomen in pregnancy (AAP). Its presentation is non-specific and requires a high index of suspicion with a low threshold to obtain radiographic imaging for diagnosis. Evaluating AAP is challenging as diagnostic radiographic imaging is often limited in relation to radiation exposure to the developing fetus. We describe a case of a 24-year-old pregnant female who presented with severe acute abdominal pain. The patient’s pain was refractory to intravenous analgesics and ultrasonography was inconclusive. Computed tomography (CT) scan was not obtained due to the risk of radiation exposure to the developing fetus. Due to the persistence of pain and suspicions for other serious etiologies, magnetic resonance imaging (MRI) was completed and the patient was diagnosed with acute unilateral adrenal infarction. In this case report, unilateral adrenal infarction was likely secondary to elevated plasma factor VIII levels. Even with the physiological elevation of factor VIII levels during pregnancy, levels greater than 150 IU/dL confer greater than five-fold increased risk of venous thrombosis. Once hemorrhage is excluded, patients should be started on therapeutic anticoagulation to prevent progression of adrenal infarct or infarction of the contralateral adrenal gland. Prompt recognition and treatment of acute adrenal infarction during pregnancy are of paramount importance to prevent adverse outcomes for both the mother and fetus.