Acute adrenal infarction can occur during pregnancy. It can go undiagnosed if an MRI is not performed. At delivery the newborn is typically healthy.

Frequency: uncommon


Pathogenesis: thrombosis of the adrenal vein, possibly due to contracture of the vein or due to hypercoagulability


Clinical features:

(1) presentation with acute flank or abdominal pain

(2) presence of flank or costovertebral angle tenderness

(3) acute infarction of the adrenal gland identified on MRI imaging studies

(4) no other cause for pain evident


MRI changes:

(1) unilateral enlargement of the adrenal gland with lengthening

(2) increased T2 signal intensity in the infarcted region

(3) surrounding edema

(4) absence of T1 signal intensity associated with hemorrhage


Usually there is no sign of adrenal insufficiency. In theory adrenal insufficiency could occur if there was bilateral infraction.

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