Adrenal infarction is usually associated with bilateral adrenal hemorrhage in the setting of antiphospholipid syndrome or hemodynamic variation. A few cases of unilateral non-hemorrhagic adrenal infarction (NHAI) have been described in the literature. Here, we report a case of unilateral non-haemorrhagic adrenal infarction occurring during pregnancy and a literature review of this clinical entity. 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 uptake after injection. Contractions persisted despite medical care and she delivered a healthy girl, weighting around 2500 g. Abdominal pain decreased right after delivery. No treatment was administered as the patient was healthy. At 3 month, CT scan imaging showed an atrophy of the right adrenal and a normal left adrenal. The patients adrenal hormonal function was normal. Accurate diagnosis of NHAI may be difficult as its clinical presentation is not specific. It can only be performed with adrenal imaging. Magnetic resonance imaging (MRI) shows diffuse enlargement of one or both adrenals as well as increased signal intensity on T2-weighted images. Anticoagulation therapy may be discussed. Patients should be evaluated between 3 and 6 months after the event to assess adrenals size and function. In summary, NHAI during pregnancy is probably underdiagnosed and obstetricians should be aware of this diagnosis.
18 - 21 May 2019
European Society of Endocrinology