Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy.
Gynecol Endocrinol. 2023 Dec;39(1):2234492. doi: 10.1080/09513590.2023.2234492.
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.
单侧非出血性肾上腺梗死（NHAI）是妊娠急性腹痛的一种罕见病因。由于其罕见性、临床表现的异质性和初始检查的不明确性，诊断极具挑战性。及时识别对于确保最佳结局至关重要。本文描述了一例在我们中心 32 周妊娠的单胎孕妇中诊断出的自发性单侧 NHAI，并对该主题进行了广泛的文献回顾。我们共确定了 22 篇文章，其中描述了 30 例产科患者中的 31 例 NHAI 病例：NHAI 更常发生在右侧和妊娠晚期，50%的病例在临床症状出现后 24 小时以上才确诊；二级影像学检查对于明确诊断和开始适当治疗总是必要的。需要高度的临床怀疑来迅速识别妊娠中的 NHAI，从而允许进行适当的多学科管理和及时治疗启动。提高对 NHAI 作为妊娠急性腹痛潜在病因的认识和意识对于改善临床实践并最终改善围产儿结局是必要的。
