Unilateral nonhaemorrhagic adrenal infarction as a cause of abdominal pain during pregnancy
Unilateral nonhaemorrhagic adrenal infarction as a cause of abdominal pain during pregnancy
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DOI：
10.1080/09513590.2019.1622088
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发表时间：
2019-05-30
影响因子：
2
通讯作者：
Christin-Maitre, S.
中科院分区：
文献类型：
--
作者：
Chasseloup, F.;Bourcigaux, N.;Christin-Maitre, S.
在抗磷脂综合征或血流动力学改变的情况下，肾上腺梗死通常伴有双侧肾上腺出血。文献中描述了少数单侧非出血性肾上腺梗塞（NHAI）病例。在这里，我们报告一个发生在怀孕期间的病例。一位30岁的女性在怀孕32周时突然出现右腹痛和宫缩。计算机断层扫描（CT）后诊断为单侧肾上腺梗死。显示右肾上腺增大，无过度强化。由于持续的宫缩，尽管接受了医疗护理，她还是生下了一个健康的，尽管是早产的女孩。分娩后腹痛立即减轻。三个月后，CT成像显示右侧肾上腺萎缩，左侧肾上腺正常。患者的肾上腺激素功能正常。NHAI的准确诊断仍然很困难，因为其临床表现并不特异。它只能通过肾上腺成像来进行。磁共振成像显示一侧或双侧肾上腺弥漫性肿大，T2加权像显示水肿。抗凝治疗可以讨论。患者应在事件发生后3至6个月进行评估，以评估肾上腺大小和功能。总之，妊娠期NHAI可能诊断不足，产科医生应该意识到这一点或诊断困难。
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.