AND YOU THOUGHT HORMONES WERE THE PROBLEM IN PREGNANCY.

A 20-year-old woman, G2P1, presented to the labor and delivery triage with right flank pain and emesis of sudden onset without any precipitating factors. The patient denied history of trauma, anticoagulant therapy, or hypertension. At the time of admission, the patient was in severe pain, was afebrile, had a blood pressure of 139/79, and heart rate of 96. Abdominal exam revealed no tenderness to palpation without guarding or rebound. Musculoskeletal tenderness was elicited from infra-scapular region to the sacroiliac joint on the right side. Mild right costovertebral tenderness was noted. Her cervix was dilated 3cm, effaced 50 percent, with fetal station at -3, unchanged from previous visit. Fetal monitor tracing was reassuring and obstetric ultrasonogram at 22 weeks showed normal fetal anatomy. Magnetic resonance imaging (MRI) revealed T2 hyperintense signal involving and surrounding the right adrenal gland suggesting infarct.