A pictorial review of non-traumatic adrenergic crisis
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PICTORIAL ESSAY
A pictorial review of non-traumatic adrenergic crisis Pankaj Nepal 1 & Vijayanadh Ojili 2 & Sree Harsha Tirumani 3 & Gowthaman Gunabushanam 4 & Arpit Nagar 5 Received: 20 February 2020 / Accepted: 1 April 2020 # American Society of Emergency Radiology 2020
Abstract Non-traumatic adrenal crisis is a rare but critical diagnosis to make in emergency settings due to grave consequences. Various pathologies can present as acute crisis, such as spectrum of endocrine imbalance, ranging from catecholamine excess in pheochromocytomas to acute adrenal insufficiency related to glandular dysfunction. Critical manifestations may be due to structural causes related to adrenal hemorrhage, especially when they are bilateral. Oncological complications such as vascular invasion, tumoral bleed, rupture, and hormonal dysfunction can occur. Due to non-specific clinical presentation, these conditions may come as a surprise on imaging performed for other reasons. Recognition of these imaging findings is critical for appropriate patient management. Although there are few articles discussing non-traumatic emergencies in literature, this review is inclusive of all possible etiologies, thus provides a holistic approach and insight into each situation. Specific imaging approach is needed to tailor the diagnosis. This article will also discuss about the advanced imaging techniques that will complement diagnosis. Keywords Non-traumatic . Emergencies . Adrenal . Imaging
Introduction Adrenal crisis may arise either due to traumatic or nontraumatic etiologies. Former is more common and generally seen in polytrauma patients. Non-traumatic adrenal crisis desires special attention and is worth a separate imaging review because of its non-specific presentation and vague clinical * Vijayanadh Ojili [email protected] Pankaj Nepal [email protected] Sree Harsha Tirumani [email protected] Gowthaman Gunabushanam [email protected] Arpit Nagar [email protected]
symptoms. Even at times, the laboratory findings may not be supportive. A clinician must have a vigilant mind about such rare diagnoses and radiologist familiar with the imaging findings. Cross sectional imaging plays a critical role in detection and management of adrenal emergency to avert potentially life-threatening complications. [1] Causes of non-traumatic adrenal crisis can be classified according to etiology, age group, known malignancy, immune status, and geography. In this article, authors have summarized the pathophysiology of adrenal emergencies dividing them into categories such as hemorrhage, infection, endocrine and systemic manifestations, and oncological emergencies (Table 1). Some of the pathologies may have overlapping presentation. Such as adrenal hemorrhage may be seen within tumoral mass and at times adrenal hemorrhage may present with acute endocrine deficiency. For better understanding, oncological and hematological complications of adrenal tumors are separately elaborated in a section in this review. Life-threatening endocrine and systemic
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