Spontaneous Adrenal Hemorrhage During Pregnancy: A Review of the Literature and a Case Report of Successful Conservative Management

Gavrilova-Jordan, Larisa; Edmister, Whitney B.; Farrell, Michael; Watson, William J.

doi:10.1097/01.ogx.0000157357.15401.c3

Cited by 55 publications

(96 citation statements)

References 11 publications

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“…Sepsis, disseminated intravascular coagulation, lupus anticoagulant and antiphospholipid antibodies, postoperative period, trauma, and anticoagulation are the main causes of adrenal hemorrhage. On the other hand, the incidence of spontaneous adrenal hemorrhage has been reported to be 0.14%-1.1% (6). Spontaneous adrenal hemorrhage is usually unilateral, involving the right gland, and it typically presents with sudden-onset abdominal or flank pain.…”

Section: Discussionmentioning

confidence: 99%

Acute Adrenal Hemorrhage in an Elderly Patient

Acar¹,

Gülpembe²,

Akıllı³

et al. 2015

JAEMCR

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Introduction: Adrenal hemorrhage is a relatively rare condition that is caused by trauma, stress, sepsis, adrenal tumors, anticoagulation, hemorrhagic disorders, and pregnancy. In acute adrenal hemorrhage, prompt diagnosis and treatment may be life-saving, because acute adrenal hemorrhage may result in acute adrenalin insufficiency and fluid-electrolyte imbalance.Case Report: Herein we present the case of an elderly patient admitted to the emergency room with right shoulder pain that was diagnosed and treated for adrenal hematoma in a few hours.Conclusion: Acute adrenal hemorrhage is quite rare and accurate diagnosis of this condition is extremely difficult. Clinicians should be aware of this rare condition and its management in order to accomplish prompt treatment. ÖZETGiriş: Adrenal kanama oldukça nadir görülmekle birlikte travma, stres, sepsis, adrenal tümör, antikoaülan ilaçlar, kanama bozuklukları ve gebelik gibi durumlara sekonder gelişebilir. Akut adrenal kanama adrenal yetmezliğe ve sıvı-elektrolit dengesizliğine yol açabileceğinden acil tanı ve tedavi hayat kurtarıcıdır.Olgu Sunumu: Burada sağ omuz ağrısı şikayeti ile acil servise başvuran yaşlı bir hastada bir kaç saat içinde tanısı konan ve tedavisi gerçekleştirilen bir adrenal kanma sunulacaktır.Sonuç: Akut adrenal kanama çok nadirdir ve tanısı da oldukça zordur. Klinisyenler, hızlı tanı ve tedavi için bu nadir hastalığı akılda tutmalıdır.

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Section: Discussionmentioning

confidence: 99%

Acute Adrenal Hemorrhage in an Elderly Patient

Acar¹,

Gülpembe²,

Akıllı³

et al. 2015

JAEMCR

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“…The incidence of spontaneous AH has been reported between 0.14% and 1.1%, usually involving the right gland. [4] Spontaneous hemorrhage can also occur in the retroperitoneum.…”

Section: Discussionmentioning

confidence: 99%

Unilateral spontaneous adrenal hemorrhage in a young patient

Çelik

Akarsu

Dural

et al. 2015

Ulus Travma Acil Cerrahi Derg

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The objective of this study was to report an unusual case of unilateral adrenal hematoma in; a 19-year-old young man who did not have a history of any specific systemic disease. The patient was admitted to hospital with chest pain that lasted for one day. Preoperative contrast-enhanced computerized tomography evaluated an adrenal mass (sized, 10.5x12.7 cm) adjacent to the anterior of the left kidney, and findings were indicative of adrenal hematoma. The final pathological diagnosis was adrenal adenoma.

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“…Its incidence in pregnancy is not known and is extremely rare, with a prevalence of 0.14-1.1% in postmortem studies. 2 There are different theories implicated in adrenal hemorrhage of pregnancy. Adrenal gland has a rich arterial supply in the subcapsular plexus with limited venous drainage into delicate medullary sinusoids through few branches in the corticomedullary junction .In hypotension , medullary sinusoids are at risk of ischemic necrosis and when normal arterial pressure is restored,…”

Section: Discussionmentioning

confidence: 99%

“…Unilateral adrenal hemorrhage usually does not manifest with adrenal insufficiency but patients with bilateral adrenal hemorrhage may present with acute adrenal crisis which occurs only when 90% of the adrenal cortex is destroyed. 2 The diagnosis of adrenal insufficiency in pregnancy is also challenging because of the aberrations in steroidogenesis occuring in normal pregnancy .There is a markedly increased maternal and placental ACTH and cortisol synthesis and very high cortisol binding globulin levels resulting in high serum cortisol and ACTH levels in pregnancy. The diagnostic cut offs for adrenal insufficiency are not well validated in pregnancy An early morning cortisol < 3ug/dl in the nonstressed state associated with typical symptoms confirms the diagnosis and a basal or stimulated cortisol value more than 30 mcg/dl usually rules out adrenal insufficiency in pregnancy.…”

Section: Jonnalagadda K Et Al Int J Reprod Contracept Obstet Gynecolmentioning

confidence: 99%

Spontaneous bilateral adrenal hemorrhage of pregnancy

Jonnalagadda

Bhavani

Pavithran

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Spontaneous adrenal hemorrhage of pregnancy is an acute hemorrhage into the adrenal gland in pregnancy in the absence of trauma, tumor or decoagulant therapy. This can have catastrophic consequences on the mother and the baby and if the hemorrhage involves both the adrenal glands the risk is aggravated because of the high incidence of resulting adrenal insufficiency. We report a case of spontaneous bilateral adrenal hemorrhage in pregnancy resulting in adrenal crisis. A 26 year old primigravida presented at 32 weeks of gestation initially with right sided infrascapular pain and one month later with similar pain in the left side associated with high blood pressure. Imaging with ultrasound and MRI was suggestive of bilateral adrenal mass probably hemorrhage; 2 days following the second episode of pain she developed drowsiness and hypotension and a diagnosis of primary adrenal insufficiency was confirmed by a low serum cortisol and high ACTH. She stabilized with hydrocortisone therapy and the fetus was closely monitored. At 37 weeks she had a normal vaginal delivery under steroid cover. Repeat MRI abdomen 3 months after delivery showed resolution of the hemorrhage but biochemically she continued to be cortisol insufficient at 1 year of follow up. Prompt diagnosis of adrenal hemorrhage in pregnancy and treatment of adrenal insufficiency along with close fetal monitoring usually results in good perinatal outcome in spontaneous adrenal hemorrhage of pregnancy.

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Spontaneous Adrenal Hemorrhage During Pregnancy: A Review of the Literature and a Case Report of Successful Conservative Management

Cited by 55 publications

References 11 publications

Acute Adrenal Hemorrhage in an Elderly Patient

Acute Adrenal Hemorrhage in an Elderly Patient

Unilateral spontaneous adrenal hemorrhage in a young patient

Spontaneous bilateral adrenal hemorrhage of pregnancy

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