Guyon Mathilde, Degez Manon, Artifoni Mathieu, Goronflot Thomas, Misbert Emilie, Dochez Vincent, Winer Norbert
Department of Gynecology-Obstetrics, Nantes University Hospital, 44000 Nantes, France.
Department of Internal Medicine, Nantes University Hospital, 44000 Nantes, France.
J Clin Med. 2023 Sep 18;12(18):6036. doi: 10.3390/jcm12186036.
Adrenal necrosis is a rare but serious cause of abdominal pain of thrombotic origin during pregnancy. There is often a delay in diagnosis and treatment. The objective was to specify the clinical and paraclinical signs suggestive of adrenal necrosis, making it possible to improve the delay in diagnostic. The secondary objective was to establish a multidisciplinary protocol regarding management. This is a case report of pregnant women with a radiological diagnosis of adrenal gland necrosis. In parallel, we carried out a systematic review in the same period. We studied these patients' clinical, biological and radiological data. We included eight patients with a computed tomography scan diagnosis of adrenal necrosis and fifteen articles in the literature describing twenty-four cases. All the patients presented with the same symptoms. The treatment was based on curative anticoagulation. The diagnosis of adrenal gland necrosis is worth suggesting in view of the array of sudden morphine-resistant abdominal pain associated with a biological inflammatory syndrome. The diagnosis is based on the computed tomography scan. Three to six months of curative anticoagulation is recommended as well as a thrombophilia and endocrinological assessment to rule out adrenal insufficiency.
肾上腺坏死是孕期血栓形成所致腹痛的一种罕见但严重的病因。诊断和治疗往往会出现延误。目的是明确提示肾上腺坏死的临床和辅助检查体征，以便缩短诊断延误时间。次要目的是制定关于管理的多学科方案。这是一例经放射学诊断为肾上腺坏死的孕妇病例报告。同时，我们在同一时期进行了系统综述。我们研究了这些患者的临床、生物学和放射学数据。我们纳入了8例经计算机断层扫描诊断为肾上腺坏死的患者以及文献中描述24例病例的15篇文章。所有患者均表现出相同症状。治疗基于根治性抗凝。鉴于一系列与生物性炎症综合征相关的突发性吗啡抵抗性腹痛，值得考虑肾上腺坏死的诊断。诊断基于计算机断层扫描。建议进行三到六个月的根治性抗凝治疗以及进行血栓形成倾向和内分泌评估，以排除肾上腺功能不全。
