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]

• HELLP Syndrome

  Abstract Pregnancy complicated by the HELLP syndrome and antiphospholipid antibodies has not previously been documented. [ncbi.nlm.nih.gov]

• 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]

• 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]

  Other symptoms related to GC deficiency are signs associated with hypoglycemia (such as paleness, sweating, disorientation and mood swings), weakness, morning headaches and failure to thrive. [karger.com]

• 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]

• 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]

• 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]

• Erythema

  She was admitted 1-week prior with an upper respiratory infection and erythema multiforme. Clinical assessment revealed sepsis with RUQ tenderness and positive Murphy's sign. [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]

  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]

• 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]

Initial radiologic investigation in the workup of primary hyperaldosteronism is high-resolution, thin-slice (2 mm-2.5 mm) adrenal CT scanning with contrast. Aldosteronomas tend to be small and may not always be seen on CT or MRI scans. [healio.com]

• 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]

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]

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]

Prognosis The prognosis of patients with CIRCI is largely dependent on that of the underlying disease. [clinicaladvisor.com]

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 & 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 of hypercortisolism In the etiology, we differentiate between exogenous hypercortisolism stemming from long-term treatment with glucocorticosteroids, and an endogenous increased production and secretion of cortisol or ACTH. [lecturio.com]

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]

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]

Epidemiology Frequency United States Adrenal hemorrhage has been reported in 0.3-1.8% of unselected cases in autopsy studies, although extensive bilateral adrenal hemorrhage may be present in 15% of individuals who die of shock. [emedicine.medscape.com]

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]

For new insights we searched original articles after 2008; to explain relevant pathophysiology we also used published review articles. [karger.com]

Pathophysiology Although the precise mechanisms leading to adrenal hemorrhage are unclear in nontraumatic cases, available evidence has implicated adrenocorticotropic hormone (ACTH), adrenal vein spasm and thrombosis, and the normally limited venous drainage [emedicine.medscape.com]

Based on the pathophysiological considerations, an increase in cortisol after stimulation by ACTH with a primary adrenal cortex insufficiency is not possible. [lecturio.com]

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]

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]