Endocrine Abstracts

Introduction: Diagnosing acute abdominal presentations in pregnant women poses challenges due to the physiological and anatomical changes during pregnancy. The differential diagnosis is broad, encompassing both obstetric and non-obstetric causes. Among the rare occurrences, nonhemorrhagic adrenal infarction presents a particularly unusual scenario, lacking established guidelines for management and follow-up. We discuss a case of nonhemorrhagic adrenal infarction manifesting as acute abdomen during pregnancy, accompanied by a comprehensive review of existing literature.

Case: A 24-year-old woman (34+5 weeks, primigravida) presented with sudden and severe upper abdominal pain, radiating to back. Initial blood tests showed normal results. The patient had no prior medical history and no family record of thrombotic disorders. A CT angiogram of aorta revealed findings consistent with nonhemorrhagic right adrenal gland infarction. Her thrombophilia screen (including Protein C & S (a low protein S is a normal physiologic phenomenon in pregnancy), Factor V, anti-thrombin, Lupus anticoagulant, anticardiolipin IgM & IgG) and autoimmune screen was negative. A 0900 am cortisol level was 514 nmol/l. Anticoagulation therapy was initiated for a duration of 3 months. At 37 weeks gestation, the patient underwent an elective Caesarean section and delivered a healthy baby. A 6 months follow up is planned, involving repeat CT adrenals and assessment of adrenal function.

Conclusion: Pregnancy is a hypercoagulable state, and women are at a 4- to 5-fold increased risk of thromboembolism during pregnancy. Instances of adrenal infarction during pregnancy are scarcely documented in medical literature. A heightened degree of suspicion is essential for accurate diagnosis. Given the rarity of this condition, comprehensive guidelines for subsequent management remain lacking. It is crucial to acknowledge that, due to inherent risks associated with anticoagulation, it is advisable to adopt a personalized, multidisciplinary approach for management of such patients.