Key result
Non-hemorrhagic adrenal infarction in pregnancy occurs more frequently on the right side and in the third trimester, with diagnosis formulated more than 24 hours after presentation in 50% of cases.
Why the study?
Unilateral non-hemorrhagic adrenal infarction is an uncommon cause of acute abdomen in pregnancy that is challenging to diagnose, yet timely recognition is pivotal.
Case Report (n=31)
NHAI is a rare cause of acute abdomen in pregnancy that requires a high degree of clinical suspicion and second-level imaging for definitive diagnosis.
High suspicion and prompt second-level imaging needed for acute abdomen in pregnancy; leaves open validation in larger cohorts.
Unilateral non-hemorrhagic adrenal infarction (NHAI) is a very uncommon cause of acute abdomen in pregnancy. Diagnosis is highly challenging due to its rarity, heterogeneity of clinical presentation, and inconclusiveness of the initial workup. Timely recognition is pivotal to ensuring optimal outcomes. Here we describe a case of spontaneous unilateral NHAI diagnosed in a singleton pregnant woman at 32 weeks' gestation at our centre and provide the findings of an extensive literature review on the topic. We identified 22 articles describing 31 NHAI cases in 30 obstetric patients: NHAI occurs more frequently on the right side and in the third trimester, and diagnosis is formulated more than 24 h after clinical presentation in 50% of cases; second-level imaging is always necessary to reach a definitive diagnosis and start appropriate treatment. A high degree of clinical suspicion is needed to promptly recognize NHAI in pregnancy, thus allowing appropriate multidisciplinary management and timely treatment initiation. Promotion of knowledge and awareness of NHAI as a potential cause of acute abdomen in pregnancy is mandatory to improve clinical practice and, ultimately, perinatal outcomes.
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Ornaghi et al. (2023) conducted a case report in Acute spontaneous non-hemorrhagic adrenal infarction in pregnancy (n=31). Non-hemorrhagic adrenal infarction was evaluated on Clinical characteristics and diagnosis timing. Non-hemorrhagic adrenal infarction in pregnancy occurs more frequently on the right side and in the third trimester, with diagnosis formulated more than 24 hours after presentation in 50% of cases.
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