Key result
MTHFR mutation linked to nonhemorrhagic adrenal infarction during pregnancy in a rare case.
Why the study?
Abdominal pain during pregnancy has multiple etiologies and its diagnosis can be unpredictable, requiring consideration of thromboembolic states such as adrenal infarction.
Case Report (n=1)
Adrenal infarction should be considered in the differential diagnosis of ambiguous flank pain during pregnancy, as it may indicate an underlying hypercoagulable state.
Adrenal infarction warrants consideration in refractory abdominal pain in late pregnancy; single case leaves open need for prospective thrombophilia studies.
Abdominal pain is the most presenting complaint during pregnancy with multiple etiologies. The diagnosis could be unpredictable. We present a case of 36-year-old pregnant woman gravida 10 para 7 abortus 2 at 36 + 5 weeks of gestation presenting twice for an increasing left abdominal pain, not relieved despite analgesics. She was delivered for severe oligohydramnios. After delivery, she was found to have a left adrenal infarction on computed tomography scan. She was found to have two mutations of the gene MTHFR 677CC. Our presented case should remind physicians to consider the presence of thromboembolic state during pregnancy. The diagnosis of adrenal infarction should be among the differentials of an ambiguous flank pain that is resilient to medical therapy. Diagnosis in a pregnant patient can be easily confirmed with MRI, after which anticoagulation should be started and the workup for hypercoagulable state investigated.
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Jerbaka et al. (2021) conducted a case report in Left flank pain during pregnancy / Nonhemorrhagic adrenal infarction (n=1). Nonhemorrhagic adrenal infarction was evaluated on Diagnosis of left adrenal infarction. A 36-year-old pregnant woman presenting with resilient left flank pain was diagnosed with a nonhemorrhagic left adrenal infarction and found to have MTHFR 677CC mutations.
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