Spontaneous adrenal hematoma in pregnancy

Abstract

Rational: Spontaneous adrenal hematoma in pregnancy is a very rare condition. Herein we present an additional rare case of unilateral spontaneous adrenal hematoma in a pregnant woman, aiming to share this experience and summarize the signal characteristics of simple adrenal hematoma in magnetic resonance imaging (MRI). Patient concerns: A 28-year old pregnant woman was referred to our hospital with a vague paroxysmal left-side back pain at 17 weeks of gestation. Diagnosis: MR scan of the abdomen revealed an 8.1 × 7.7 × 6.8 cm round mass in the left adrenal region, which showed a rim of acute hemorrhage signal. Due to the stable condition of the patient and fetus, she was admitted for observation. Repeat MR scan was performed a month later, and it showed a stable mass with marginal subacute bleeding signal. Interventions: Laparoscope excision of the hematoma was performed. Outcomes: Simple adrenal hematoma was confirmed by pathological examinations. And the patient was discharged 3 days later with normal renal and adrenal functions. Lessons: The most important characteristic of adrenal hematoma is the high-signal rim on T1-weighted MR images, and the clinicians should make individualized treatment plan for every patient encountered in the future who might have different clinical conditions.

Spontaneous adrenal haemorrhage in pregnancy and review of the literature

“…During pregnancy, there is noted to be physiological hypertrophy and hyperplasia of the adrenal cortex in addition to an increase in adrenocorticotropic hormone. This can subsequently increase vascular supply to the adrenal gland and possibly predispose the gland to bleeding 1 5 7. Furthermore, in pregnancies complicated by pre-eclampsia, the increase in BP may also cause rupture of the adrenal vessels.…”

“…The definitive management of SAH is still undefined and depends on the likelihood of the patient developing life-threatening complications, such as haemorrhagic shock and adrenal insufficiency 2 7…”

“…Conservative, surgical and interventional treatments are the main management options for SAH in the general population as well as in pregnancy; with the recent trend in trauma literature moving towards non-operative management when possible 4 7. Conservative management, which includes intravenous fluids, pain control and serial haemoglobin assessments alongside as required blood transfusions, may be appropriate if the bleeding is less severe and the patient is haemodynamically stable 6 8.…”

Vanishing Adrenal Mass in Pregnancy

“…Unilateral adrenal hemorrhage in pregnancy is uncommon but has been recognized and reported in the literature. 1 , 2 , 3 , 4 , 5 , 6 , 7 The exact incidence rate of adrenal hemorrhage in pregnancy is unknown and often involves the right adrenal gland. 7 , 8 Adrenal hemorrhage may be spontaneous or result from contributing factors, such as pregnancy, infection, anticoagulation, hypertension, tumor, or trauma.…”

Spontaneous adrenal hematoma in pregnancy: A case report

“…The treatment depends upon the condition of patient on presentation and response to conservative management. 4 A high degree of suspicion and clinical experience is needed for diagnosis as most patients present with non-specific symptoms. If neglected, it can result in maternal mortality.…”