Methamphetamine use may be associated with a wide range of complications. A rare complication is infarction of intra-abdominal organs, including the adrenal gland.
Proposed mechanism: hypercoagulable state with increased risk of thromboembolism. Other factors may be vasospasm or hypoperfusion due to hypotension or cardiomyopathy.
Clinical features:
(1) evidence of recent methamphetamine use
(2) onset of acute abdominal pain with left paraumbilical tenderness
(3) reduced enhancement of one or both adrenal glands on contrast-enhanced CT
(4) variable presence of acute adrenal insufficiency (likely if bilateral, less likely if unilateral)
(5) variable hypotension
Other intra-abdominal organs that may show infarcts with methamphetamine use:
(1) intestines
(2) gallbladder
(3) spleen
(4) kidney
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