scholarly journals Acute Adrenal Infarct in a Pregnant Female With Severe Abdominal Pain

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A107-A108
Author(s):  
Firas Warda ◽  
Gunjan Yogendra Gandhi
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Adrenal Gland ◽  
Case Reports ◽  
Factor V Leiden ◽  
Serum Cortisol ◽  
Factor V ◽  
Left Adrenal Gland ◽  
Acth Stimulation ◽  
Adrenal Infarction

Abstract Background: The differential diagnosis for pregnant patient presenting with abdominal pain is broad. Adrenal infarction is a rare cause of such presentation. Clinical Case: A 24-year-old woman, 30 weeks pregnant, presented to the emergency room with severe, sharp, left upper quadrant abdominal pain that radiated to the back and was associated with nausea and vomiting. Abdominal exam showed tenderness to light palpation in the left upper area with voluntary guarding. Genitourinary exam revealed a closed cervical os. Abdominal MRI noted a T2 hypointense left adrenal gland with loss of normal diffusion restriction. Edematous changes were identified within the left perinephric and anterior pararenal spaces. Left adrenal gland non-hemorrhagic infarction with necrosis was diagnosed, and patient was started on enoxaparin. Patient was admitted for hydration and pain control. A morning serum cortisol was equivocal at 10.3 µg/dL with a mid-normal ACTH of 38.9 pg/mL. ACTH stimulation noted a suboptimal cortisol response with a serum cortisol at baseline of 9.1 µg/dL, at 30 minutes 10.7 µg/dL, and at 60 minutes 11.0 µg/dL. Patient was started on stress dose intravenous hydrocortisone. Evaluation for thrombophilia was undertaken and patient initiated on therapeutic weight-based enoxaparin. Investigations for etiology included normal factor V leiden, proteins C and S activity, antithrombin III antigen, antiphospholipid screening, C3 and C4 complement, anti-double stranded DNA antibody, anti-neutrophil cytoplasmic antibody, cryoglobulin, homocysteine, and factor II mutation. Factor VIII activity was increased >200%, which is within expected range during pregnancy. Patient was heterozygous for MTHFR C677T and A1298C mutations. Hydrocortisone was tapered and patient discharged on a physiologic dose, in addition to enoxaparin. Conclusion: Unilateral adrenal infarction is an uncommon entity in general, and even more uncommon during pregnancy (1). Thrombophilia evaluation is warranted as antiphospholipid syndrome and MTHFR gene mutations have been associated with this condition. Given the rarity of this disease, it may not be included in the differential diagnosis of pregnant patients who present with acute abdominal pain. MRI is superior to other imaging modalities due to its sensitivity in detecting adrenal infarct and even hemorrhage, if present. Unfortunately, there are no guideline on managing such patients, but the focus is usually placed on anticoagulation to prevent the infarction of the contralateral adrenal gland, with cautious monitoring as hemorrhagic conversion is possible. Screening patient for adrenal insufficiency for prompt supplementation of corticosteroids if needed is necessary, while attempting to find the underlying cause. Reference: (1) Green P., et al. Unilateral adrenal infarction in pregnancy. BMJ Case reports. 2013; bcr2013009997

Neonatal aortic arch thrombosis: analysis of thrombophilic risk factors and prognosis

2013 ◽  
Vol 24 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Ivonne Wieland ◽  
Thomas Jack ◽  
Kathrin Seidemann ◽  
Martin Boehne ◽  
Florian Schmidt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Aortic Arch ◽  
Case Reports ◽  
Statistical Significance ◽  
Rare Event ◽  
Factor V Leiden ◽  
High Rate ◽  
Factor V ◽  
Factor V Leiden Mutation

AbstractArterial thrombosis in neonates and children is a rare event and is often associated with external risk factors such as asphyxia or sepsis. We report our experiences with two neonates with spontaneous aortic arch thrombosis mimicking aortic coarctation. Despite single case reports until now, no data exist for the underlying thrombophilic risk factors and prognosis of this rare event. Both patients were carriers of a heterozygous factor V Leiden mutation, which has been reported once before as a risk factor for aortic arch thrombosis. One of our patients was operated upon successfully and is alive. The second patient suffered a large infarction of the right medial cerebral artery and had a thrombotic occlusion of the inferior caval vein. The patient obtained palliative care and died at the age of 6 days. In the literature, we identified 19 patients with neonatal aortic arch thrombosis. Of the 19 patients, 11 (58%) died. Including the two reported patients, the mortality rate of patients with multiple thromboses was 80% (8/10) compared with 18% (2/11) for patients with isolated aortic arch thrombosis; this difference reached statistical significance (p = 0.009). The analysis of thrombophilic disorders revealed that factor V Leiden mutation and protein C deficiency seem to be the most common risk factors for aortic arch thrombosis.Conclusion:Neonatal aortic arch thrombosis is a very rare but life-threatening event, with a high rate of mortality, especially if additional thrombotic complications are present. Factor V Leiden mutation seems to be one important risk factor in the pathogenesis of this fatal disease.

scholarly journals Primary adrenal insufficiency due to bilateral adrenal infarction in COVID-19: a case report

2021 ◽  
Author(s):  
Iza F R Machado ◽  
Isabel Q Menezes ◽  
Sabrina R Figueiredo ◽  
Fernando Morbeck Almeida Coelho ◽  
Debora R B Terrabuio ◽  
...  
Keyword(s):  
Case Report ◽  
Adrenal Insufficiency ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Case Reports ◽  
Serum Cortisol ◽  
Primary Adrenal Insufficiency ◽  
Acute Adrenal Insufficiency ◽  
Adrenal Infarction ◽  
New Onset

Abstract Context Coronavirus disease 2019 (COVID-19) is a proinflammatory and prothrombotic condition, but its impact on adrenal function has not been adequately evaluated. Case report A 46-year-old woman presented with abdominal pain, hypotension, skin hyperpigmentation after COVID-19 infection. The patient had hyponatremia, serum cortisol <1.0 ug/dL, ACTH of 807 pg/mL and aldosterone <3 ng/dL. Computed tomography (CT) findings of adrenal enlargement with no parenchymal and minimal peripheral capsular enhancement after contrast were consistent with bilateral adrenal infarction. The patient had autoimmune hepatitis and positive antiphospholipid antibodies, but no previous thrombotic events. The patient was treated with intravenous hydrocortisone, followed by oral hydrocortisone and fludrocortisone. Discussion Among 115 articles, we identified nine articles, including case reports, of new-onset adrenal insufficiency and/or adrenal hemorrhage/infarction on CT in COVID-19. Adrenal insufficiency was hormonally diagnosed in five cases, but ACTH levels were measured in only three cases (high in one case and normal/low in other two cases). Bilateral adrenal non- or hemorrhagic infarction was identified in five reports (two had adrenal insufficiency, two had normal cortisol levels and one case had no data). Interestingly, the only case with well-characterized new-onset acute primary adrenal insufficiency after COVID-19 had a previous diagnosis of antiphospholipid syndrome. In our case, antiphospholipid syndrome diagnosis was established only after the adrenal infarction triggered by COVID-19. Conclusions Our findings support the association between bilateral adrenal infarction and antiphospholipid syndrome triggered by COVID-19. Therefore, patients with positive antiphospholipid antibodies should be closely monitored for symptoms or signs of acute adrenal insufficiency during COVID-19.

scholarly journals Acute Respiratory Distress Syndrome and Feculent Airway Casts due to Severe Constipation

2021 ◽  
Author(s):  
Eric Mull ◽  
Brooke Gustafson ◽  
Brent Adler ◽  
Katelyn Krivchenia
Keyword(s):  
Differential Diagnosis ◽  
Acute Respiratory Distress Syndrome ◽  
Abdominal Pain ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Case Reports ◽  
Severe Constipation ◽  
History Of

Acute respiratory distress syndrome (ARDS) is a disabling and potentially lethal syndrome requiring prompt recognition and urgent interventions to prevent morbidity and mortality[1]. Although constipation is not generally recognized as a cause for ARDS or usually listed within the differential diagnosis, there have been case reports describing such an association[2,3]. We present the case of a patient with history of intermittent constipation presenting with progressive abdominal pain and an acute abdomen that required emergent surgical fecal decompaction. This was followed by hypoxemic respiratory distress leading to respiratory failure in the setting of severe constipation and aspirated feculent material. To our knowledge, this is the first published case report describing aspirated feculent material in a child with respiratory failure due to ARDS.

Factor V Leiden Mutation–Related Chronic Skin Ulcers

2013 ◽  
Vol 12 (1) ◽  
pp. 35-38 ◽  
Author(s):  
Kadir Kayatas ◽  
Filiz Cebeci ◽  
Cumali Karatoprak ◽  
Muhammet Benzer ◽  
Refik Demirtunç ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Skin Biopsy ◽  
Hyperbaric Oxygen ◽  
Factor V Leiden ◽  
Skin Lesions ◽  
Factor V ◽  
Factor V Leiden Mutation ◽  
Woman Patient ◽  
Skin Ulcers ◽  
Chronic Skin

Chronic skin ulcers require extensive, systemic differential diagnosis; thus, they are difficult to diagnose and treat. Transient or persistent hypercoagulable states are among the rare causes of skin ulcers. Here, we present the case of a 27-year-old woman patient with recurrent, nonhealing skin ulcers of 8 years’ duration, who had been treated unsuccessfully with various medications under different diagnoses at different clinics. On admission, a skin biopsy demonstrated occlusive vasculopathy, and the search for an inherited hypercoagulable state revealed a heterozygous factor V Leiden mutation. The patient was treated with anticoagulants and hyperbaric oxygen. On treatment, the skin lesions healed and did not recur.

scholarly journals Mature (Benign) Cystic Retroperitoneal Teratoma Involving the Left Adrenal Gland in a 22-Year-Old Male: A Case Report and Literature Review

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Adnan Bhatti ◽  
Hindi Al-Hindi ◽  
Ayman Azzam ◽  
Tarek Amin ◽  
Ahmed Abu-Zaid
Keyword(s):  
Literature Review ◽  
Adrenal Gland ◽  
Adrenal Glands ◽  
Case Reports ◽  
Healthy Male ◽  
Left Adrenal Gland ◽  
Retroperitoneal Teratoma ◽  
History Of ◽  
Left Flank Pain ◽  
Primary Retroperitoneal

Primary retroperitoneal teratomas involving adrenal glands are exceedingly uncommon accounting for only 4% of all primary teratomas. They are more common in childhood and rarely occur in adults. Only a very few case reports have been documented in literature so far. Herein, we report a mature (benign) cystic retroperitoneal teratoma in the region of left adrenal gland in a 22-year-old otherwise healthy male patient who presented with a 1-month history of left flank pain. In addition, a literature review on teratomas is included.

scholarly journals Adrenal infarction in a healthy pregnant woman

2016 ◽  
Vol 9 (2) ◽  
pp. 90-92 ◽  
Author(s):  
Heidi Sormunen-Harju ◽  
Krista Sarvas ◽  
Niina Matikainen ◽  
Nanna Sarvilinna ◽  
E Kalevi Laitinen
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Pregnant Woman ◽  
Acute Abdomen ◽  
Rare Event ◽  
Normal Pregnancy ◽  
Healthy Pregnant Woman ◽  
Upper Abdominal ◽  
Adrenal Infarction ◽  
In Pregnancy

Adrenal infarction is a very rare event but occasionally seen in hypercoagulable states. We present a case of a 31-year-old woman at 38 weeks of gestation who developed a severe upper abdominal pain and unilateral adrenal infarction due to thrombosis of the adrenal vein. The only thrombogenic factor found was pregnancy. The case highlights that adrenal infarction may complicate a normal pregnancy and should be included in the differential diagnosis of the acute abdomen in pregnancy.

The diagnosis and investigation of adrenal insufficiency in adults

2009 ◽  
Vol 46 (5) ◽  
pp. 351-367 ◽  
Author(s):  
Ian Wallace ◽  
Sean Cunningham ◽  
John Lindsay
Keyword(s):  
Differential Diagnosis ◽  
Adrenal Insufficiency ◽  
Dynamic Testing ◽  
Serum Cortisol ◽  
Evidence Base ◽  
Acth Stimulation ◽  
Accurate Identification ◽  
Testing Protocols ◽  
Pituitary Adrenal Axis

There is considerable variation in the methods used to diagnose and investigate adrenal insufficiency in clinical practice. These include a range of adrenocorticotropin (ACTH) stimulation and other dynamic testing protocols, serum cortisol cut-off values for diagnosis and tests used for differential diagnosis. With the introduction of modern cortisol and ACTH assays, the interpretation of tests used for diagnosis and differential diagnosis has become more complex and requires local validation. This review examines the basis of normal hypothalamic–pituitary–adrenal axis function and adrenal insufficiency states based upon an evidence base accumulated over the past four decades. The role of the laboratory in the differential diagnosis and interpretation based upon assay methodology is discussed. The accurate identification of patients who may benefit from corticosteroid replacement in special settings such as critical illness is challenging and will be explored.

scholarly journals IS ACROMEGALY A HYPERCOAGULABLE CONDITION? CASE REPORTS AND REVIEW OF THE LITERATURE

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Khalid Al Dahmani ◽  
Churn-Ern Yip ◽  
David Anderson ◽  
Karen Burch ◽  
David B Clarke ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Medical Therapy ◽  
Case Reports ◽  
Factor V Leiden ◽  
Acute Chest Pain ◽  
Protein S ◽  
Cardiovascular Complications ◽  
Factor V ◽  
Axillary Vein ◽  
Increased Risk

Introduction: Cardiovascular complications are a major cause of morbidity and mortality in patients with uncontrolled acromegaly. However, there are no published reports of an increased risk of venous thromboembolism (VTE) in such patients. We report three patients with uncontrolled acromegaly who presented with VTE. Clinical Cases: A 52-year-old male with uncontrolled acromegaly despite transsphenoidal (TSP) surgery and medical therapy presented in 2012 with acute chest pain and shortness of breath that was later con rmed as secondary to pulmonary embolism. A 44-year-old male immigrant, previously treated for acromegaly with radiation therapy alone, in 1992, in his native country, was referred to our centre in 2006 for acromegaly which remained uncontrolled despite medical therapy until 2009 when he achieved remission through TSP surgery. He had several episodes of VTE between 2008 and 2010. A 69-year-old male with uncontrolled acromegaly for 28 years despite two surgical resections and radiation therapy in 1986 and 1992, as well as continuous medical therapy, presented with VTE of the right axillary vein and bilateral pulmonary emboli in 2011. A thrombophilia screen in case 1 showed mild protein S de ciency, case 2 was homozygous for factor V Leiden (FVL) mutation and case 3 was heterozygous for FVL. Extensive investigations revealed no evidence of malignancy and echocardiography showed preserved ejection fraction in all three patients. Conclusion: Patients with uncontrolled acromegaly may be at increased risk of VTE. However, larger studies are required to further assess this association and determine the underlying cause. Key words: Acromegaly, pituitary tumours, thromboembolism 

scholarly journals Asymptomatic superior mesenteric vein thrombosis as unusual complication of acute cytomegalovirus infection: a case report

2015 ◽  
Vol 9 (3) ◽  
Author(s):  
Michele Bertoni ◽  
Filippo Risaliti ◽  
Alessandra Giani ◽  
Emanuele Calabrese ◽  
Massimo Edoardo Di Natale
Keyword(s):  
Superior Mesenteric Vein ◽  
Case Reports ◽  
Factor V Leiden ◽  
Portal System ◽  
Unusual Complication ◽  
Factor V ◽  
Cmv Infection ◽  
Oral Anticoagulant Treatment ◽  
Factor V Leiden Mutation ◽  
Mesenteric Vein

We describe a 39-year-old male who presented with a fever of unknown origin the diagnostic work-up of which disclosed an acute CMV infection complicated by a partial superior mesenteric vein (SMV) thrombosis. Further investigations revealed the presence of factor V Leiden mutation. Oral anticoagulant treatment with warfarin lead to a complete recanalization of SMV two months after. A literature review on the association between CMV infection and portal system (PS) thrombosis in immunocompetent patients was performed. We found that, in agreement with our case, in a minority of case reports patients did not complain of abdominal pain, but presented with a mononucleosic-like syndrome with malaise and prolonged fever and displayed a variable elevation of aminotransferase levels. Interestingly, most of them exhibited a limited extension of portal thrombosis. On the whole, these data suggest that PS thrombosis during acute CMV infection may be an underestimated complication.

scholarly journals Retroperitoneal mature cystic teratoma involving the left adrenal gland in a 75-year-old male: a case report and literature review

2020 ◽  
Vol 2020 (11) ◽  
Author(s):  
André Tojal ◽  
Natália Santos ◽  
João Vicente ◽  
Noel Carrilho ◽  
Carlos Casimiro
Keyword(s):  
Literature Review ◽  
Adrenal Gland ◽  
Histopathological Examination ◽  
Case Reports ◽  
Therapeutic Option ◽  
Adrenal Adenoma ◽  
Cystic Teratoma ◽  
Left Adrenal Gland ◽  
Invasive Approach ◽  
Retroperitoneal Teratoma

Abstract Primary retroperitoneal teratomas involving adrenal glands are extremely uncommon, particularly in elderly males. Only a few case reports have been documented in the literature so far. We report a mature cystic retroperitoneal teratoma in the region of left adrenal gland in an asymptomatic 75-year-old male patient. It was incidentally found on an abdominal computed tomography scan and was thought to be an adrenal adenoma. Because of its relatively large size and the patient’s request, he underwent a laparoscopic left adrenalectomy. Histopathological examination revealed a benign mature cystic retroperitoneal teratoma in the region of the left adrenal gland. The patient had an uneventful postoperative course and is free of recurrence after 20 months of follow-up. Considering the diagnostic difficulty of retroperitoneal teratoma by radiologic imaging, and its risk of malignancy, surgical resection via a minimally invasive approach would be the best diagnostic and therapeutic option. A literature review on teratomas is included.

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