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Adrenal Infarction


Presentation

  • A 20-year-old woman, gravida 1 para 0, presented at 27 4/7 weeks of gestation with sudden-onset right upper quadrant and flank pain.[ncbi.nlm.nih.gov]
  • A 40-year-old woman with antiphospholipid syndrome presented with a 5-day history of right upper quadrant (RUQ) pain, radiating posteriorly, associated with fever and vomiting.[ncbi.nlm.nih.gov]
  • We report a case of a 29-year-old pregnant woman at the twenty-fourth week of gestation that presented with an acute episode of severe localized right upper quadrant pain.[ncbi.nlm.nih.gov]
  • A 25-year-old pregnant woman at 28 weeks gestational age presented with increasing abdominal pain and was found to have a unilateral adrenal infarction on a CT scan of the abdomen. Her medical history was unremarkable.[ncbi.nlm.nih.gov]
Virilization
  • […] the very first ritual of assigning sex becomes shrouded with uncertainty; the revitalized pa tient with hitherto undiagnosed Addison's disease, who but for the cognitive powers of the endocrinologist would have ultimately succumbed, undiagnosed; the virilized[books.google.com]
HELLP Syndrome
  • Abstract Pregnancy complicated by the HELLP syndrome and antiphospholipid antibodies has not previously been documented.[ncbi.nlm.nih.gov]
Hemophilia A
  • Hemophilia and related conditions — congenital deficiencies of prothrombin (factor II), factor V and factors VII to XII. In: Williams W.J., Beutler E., Erslev A.J., Lichtman M.A. (Eds.), Hematology.[link.springer.com]
Right Upper Quadrant Pain
  • We report a case of a 29-year-old pregnant woman at the twenty-fourth week of gestation that presented with an acute episode of severe localized right upper quadrant pain.[ncbi.nlm.nih.gov]
  • Nkiruka Okagbue Women’s Health Department, Medway NHS Trust A 24 year old pregnant woman presented at 33 6 weeks of gestation with severe right upper quadrant pain. She was found to have a right sided adrenal infarct on CT and MRI scan.[epostersonline.com]
Severe Abdominal Pain
  • Adrenal infarction is an infrequent cause of severe abdominal pain during pregnancy. The magnetic resonance imaging (MRI) features of adrenal infarction have not previously been thoroughly described.[ncbi.nlm.nih.gov]
  • […] doi: 10.1097/AOG.0000000000000884 Contents: Case Report Abstract In Brief Author Information Authors Article Metrics Metrics Adrenal infarction is an infrequent cause of severe abdominal pain during pregnancy.[journals.lww.com]
Upper Abdominal Pain
  • Krestin, Bilateral adrenal swelling as a cause of chest, back, and upper abdominal pain in essential thrombocythemia and polycythemia vera is due to microvascular ischemic thrombosis rather than to hemorrhage, 10.1007/s00277-002-0500-5 Kojima K., Fujii[dial.uclouvain.be]
Recurrent Abdominal Pain
  • Case history: A 55-year woman presented with 1-week history of recurrent abdominal pain and tenderness in left upper quadrant and loin. There was no pigmentation of the skin or mucous membranes.[endocrine-abstracts.org]
Failure to Thrive
  • Fred Ferri’s popular "5 books in 1" format provides quick guidance on menorrhagia, Failure to Thrive (FTT), Cogan’s syndrome, and much more.[books.google.de]
Murphy's Sign
  • Clinical assessment revealed sepsis with RUQ tenderness and positive Murphy's sign. Laboratory results showed raised inflammatory markers, along with renal and liver impairment. CT showed bilateral adrenal infarction and inferior vena cava thrombus.[ncbi.nlm.nih.gov]
Spontaneous Rupture of Membranes
  • At 32 weeks she experienced spontaneous rupture of membranes. One week later she delivered vaginally and remained anticoagulated for the puerperium.[ncbi.nlm.nih.gov]
Suggestibility
  • This case highlights the importance of a high index of suspicion for adrenal infarction in pregnancy on the clinical grounds of otherwise unexplained acute abdominal pain accompanied by suggestive radiological findings, especially in the presence of thrombophilia[ncbi.nlm.nih.gov]
  • It is suggested that the factors responsible for the initiation of thrombosis in the adrenal veins are catecholamines, thrombin, fibrin and endotoxin.[ncbi.nlm.nih.gov]
  • Access full-color images and more than 90 online-only topics at Expert Consult, as well as EBMs, Suggested Reading, Patient Teaching Guides, and additional algorithms.[books.google.de]
  • Access full-color images and 65 online-only topics at Expert Consult, as well as online-only contents including EBMs, Suggested Reading, Patient Teaching Guides, and additional algorithms.[books.google.de]
Meningism
  • Ferri’s popular "5 books in 1" format provides quick guidance on short QT syndrome, microscopic polyangiitis, fungal meningitis, and much more. This medical reference makes the answers you need even easier to find - anytime, anywhere.[books.google.de]
  • If the causal agent is suspected to be meningitis a lumbar puncture is performed. If the causal agent is suspected to be bacterial a blood culture and complete blood count is performed.[en.wikipedia.org]
  • Infiltration or infection - eg, sarcoidosis, haemachromatosis, lymphocytic hypophysitis, TB, meningitis.[patient.info]
Flank Pain
  • A 20-year-old woman, gravida 1 para 0, presented at 27 4/7 weeks of gestation with sudden-onset right upper quadrant and flank pain.[ncbi.nlm.nih.gov]
  • pain Confusion, loss of consciousness, or coma Dehydration Dizziness or light-headedness Fatigue, severe weakness Headache High fever Loss of appetite Low blood pressure Nausea, vomiting Rapid heart rate Rapid respiratory rate Slow, sluggish movement[adrenal-insufficiency.nz]
  • Adrenal hemorrhage often causes abdominal or flank pain and fever; CT scan of the abdomen reveals high-density bilateral adrenal masses.[unboundmedicine.com]
  • Adrenal infarction is a rare cause of flank pain. It is usually due to thrombosis of the main adrenal vein or secondary to microvascular thrombosis within the parenchyma of the adrenal gland.[epostersonline.com]
Flank Pain
  • A 20-year-old woman, gravida 1 para 0, presented at 27 4/7 weeks of gestation with sudden-onset right upper quadrant and flank pain.[ncbi.nlm.nih.gov]
  • pain Confusion, loss of consciousness, or coma Dehydration Dizziness or light-headedness Fatigue, severe weakness Headache High fever Loss of appetite Low blood pressure Nausea, vomiting Rapid heart rate Rapid respiratory rate Slow, sluggish movement[adrenal-insufficiency.nz]
  • Adrenal hemorrhage often causes abdominal or flank pain and fever; CT scan of the abdomen reveals high-density bilateral adrenal masses.[unboundmedicine.com]
  • Adrenal infarction is a rare cause of flank pain. It is usually due to thrombosis of the main adrenal vein or secondary to microvascular thrombosis within the parenchyma of the adrenal gland.[epostersonline.com]

Workup

Treponema Pallidum
  • The results of autoantibody screening, including Treponema pallidum haemagglutination, Veneral Disease Experimental Laboratory test, antinuclear and anti-DNA antibodies, cryoglobulin, and rheumatoid factor were negative.[ard.bmj.com]

Treatment

  • Also has boxes featuring controversial areas of treatment. Practical and clinically orientated. Major changes to resuscitation guidelines. Complete rewriting of ENT section.[books.google.com]
  • Treatment consisted in painkillers and treating the underlying condition in order to prevent further thrombotic events. metadata References J. Michiels, Z. Berneman, W. Schroyens, G.[dial.uclouvain.be]
  • Anticoagulation treatment was begun. Figure 1 (A) and (B) Bilateral enlarged adrenal glands, secondary to adrenal haemorrhagic infarction confirmed by computed tomography.[ard.bmj.com]
  • Bilateral massive adrenal hemorrhage: early recognition and treatment. Ann. Intern. Med. 110 : 227, 1989. PubMed CrossRef Google Scholar 4. Alford W.C., Meador C.K., Mihalevich J., Burrus G.R., Glassford D.M., Stoney W.S., Thomas C.S.[link.springer.com]
  • You will need to go to the hospital for treatment and monitoring. If infection or another medical problem caused the crisis, you may need additional treatment.[adrenal-insufficiency.nz]

Prognosis

  • Outlook (Prognosis) Shock may occur if treatment is not provided early, and it can be life threatening.[adrenal-insufficiency.nz]
  • The prognosis for any patient with adrenal insufficiency will depend on the underlying cause. In those patients in whom the prognosis is not affected by the underlying pathology, replacement therapy should result in a return to health.[patient.info]
  • The prognosis of acute bilateral adrenal hemorrhage remains good so long as patients undergo appropriate treatment, including anticoagulation and corticosteroid replacement therapy.[consultant360.com]
  • Prognosis The prognosis of patients with CIRCI is largely dependent on that of the underlying disease.[clinicaladvisor.com]
  • Prognosis & Response totherapyLife expectancy is usually normal with good compliance.It is important to make sure that pt is taking medications regularly and knowledgeable about his condition.BP without orthostatic hypotension, normal lytes, PRA 28.[slideshare.net]

Etiology

  • Other Tests That May Prove Helpful Diagnostically For the etiology of adrenal insufficiency acute or chronic several other tests are helpful.[endocrinologyadvisor.com]
  • Less common etiologies include adrenoleukodystrophy that causes adrenal failure in young men and drugs such as ketoconazole and etomidate that inhibit steroid hormone synthesis.[unboundmedicine.com]
  • Classified as primary or secondary in etiology, but both types can lead to adrenal crisis.[emdocs.net]
  • Etiology Primary Adrenal Insufficiency Adrenal Hemorrhage/Infarction/Loss Anti-Phospholipid Antibody Syndrome (see Anti-Phospholipid Antibody Syndrome, [[Anti-Phospholipid Antibody Syndrome]]) Bilateral Adrenalectomy : after bilateral nephrectomy or in[mdnxs.com]
  • Clinical Weakness, hypotension, easy fatigability, weight loss, N&V, abdominal pain, muscle and joint pain, amenorrhea, bronzing of the skin and hyperpigmentation-especially at skin folds Management Hydrocortisone, fludrocortisone 1 0 Adrenal insufficiency Etiology[medical-dictionary.thefreedictionary.com]

Epidemiology

  • : found in 40% of primary adrenal insufficiency cases at initial presentation Hyponatremia (see Hyponatremia, [[Hyponatremia]]) Epidemiology : found in 80% of primary adrenal insufficiency cases at initial presentation Mechanism : primariliy caused by[mdnxs.com]
  • EPIDEMIOLOGY Prevalence: 12 per 100,000 persons Incidence: 0.5 per 100,000 persons Age: may occur at any age, with peak incidence in the fourth decade Sex: Autoimmune causes: female predominance Non-autoimmune causes: equal sex distribution 10.[slideshare.net]
  • Epidemiology There is increasing evidence that in many critically ill patients activation of the HPA axis and the release of cortisol is impaired (AI).[clinicaladvisor.com]
  • Epidemiology [ 1, 2 ] Primary insufficiency - this is a relatively rare condition. The annual incidence is about 1 in 10,000 people, with a prevalence in the UK of about 8,400. Across Europe, prevalence is estimated as 93-144 per million.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology The mechanisms leading to inadequate cortisol production during critical illness are complex and poorly understood and likely include decreased production of CRH, ACTH, and cortisol.[clinicaladvisor.com]
  • The pathophysiology of this is not yet clear. It involves reduction in the production of glucocorticoids as well as reduced effect.[patient.info]

Prevention

  • The patient was anticoagulated to prevent contralateral thrombosis. At 32 weeks she experienced spontaneous rupture of membranes. One week later she delivered vaginally and remained anticoagulated for the puerperium.[ncbi.nlm.nih.gov]
  • This case illustrates the importance of promptly recognising adrenal insufficiency in patients with antiphospholipid syndrome and the possible causative agents, which require careful consideration and exclusion to prevent further thrombotic events.[ncbi.nlm.nih.gov]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.de]
  • Treatment consisted in painkillers and treating the underlying condition in order to prevent further thrombotic events. metadata References J. Michiels, Z. Berneman, W. Schroyens, G.[dial.uclouvain.be]

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