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A pictorial review of non-traumatic adrenergic crisis

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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.

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Acknowledgments

Our patients, the great source of learning.

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Authors and Affiliations

  1. St. Vincent’s Medical Center, Bridgeport, CT, USA

    Pankaj Nepal

  2. University of Texas Health, San Antonio, TX, USA

    Vijayanadh Ojili

  3. University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Sree Harsha Tirumani

  4. Yale University School of Medicine, New Haven, CT, USA

    Gowthaman Gunabushanam

  5. Ohio State University Wexner Medical Center, Columbus, OH, USA

    Arpit Nagar

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  1. Pankaj Nepal
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Correspondence to Vijayanadh Ojili.

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Nepal, P., Ojili, V., Tirumani, S. et al. A pictorial review of non-traumatic adrenergic crisis. Emerg Radiol 27, 533–545 (2020). https://doi.org/10.1007/s10140-020-01777-2

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