Spontaneous adrenal hemorrhage during pregnancy: review of literature and case report of successful conservative management

Spontaneous Adrenal Hemorrhage in Pregnancy: A Case Series

“…If unrecognized, adrenal hemorrhage can lead to adrenal crisis, shock, and theoretically death for both mother and fetus and should be considered in the differential diagnosis of abdominal pain in pregnancy [3, 4]. Presenting symptoms are similar to those in nonpregnant patients and include acute onset flank, abdominal or even chest pain, nausea, vomiting, or hypotension [4, 5].…”

“…Presenting symptoms are similar to those in nonpregnant patients and include acute onset flank, abdominal or even chest pain, nausea, vomiting, or hypotension [4, 5]. In order to be classified as spontaneous and idiopathic there can be no history of trauma, anticoagulation, tumor, or sepsis [2, 4–6]. …”

“…MRI or CT scan is needed to confirm the diagnosis and to evaluate for potential underlying etiology such as pheochromocytoma or malignant tumor [2]. On MRI, adrenal hemorrhage appears as a heterogeneous mass with enlargement of one or both adrenal glands while a contrast CT scan demonstrates adrenal echogenicity, streaky appearance of the perirenal fat, perinephric hematoma, or a retroperitoneal hematoma in a massive bleed [2, 4]. A follow-up MRI or CT scan is usually recommended to confirm stability or resolution of the hematoma, especially if a conservative approach is adopted.…”

“…A high index of suspicion is necessary to diagnose SAH as most patients present with nonspecific symptoms including abdominal or flank pain and fever [2, 3]. Rarely, patients can develop massive retroperitoneal bleeding and present with hemodynamic instability [1, 4, 5]. If bilateral, SAH can lead to adrenal crisis and shock necessitating emergency laparotomy and adrenalectomy [2, 5].…”

Spontaneous Unilateral Adrenal Hemorrhage in Pregnancy

“…Abdominal pain is a common symptom in pregnancy and rarely is adrenal hemorrhage high on the list of differential diagnoses. Spontaneous adrenal hemorrhage (SAH) is an uncommon condition that if misdiagnosed can lead to adrenal crises [ 1 ]. SAH can occur in the absence of trauma or during the use of anticoagulants.…”