Spontaneous Adrenal Hemorrhage in Pregnancy Presenting as a Pulmonary Embolism

Laack, Jonathan; Trigger, Christopher

doi:10.1016/j.jemermed.2015.08.014

Cited by 3 publications

(5 citation statements)

References 4 publications

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“…Other symptoms like neuropsychiatric presentations, hypotension and anaemia are uncommon (27). A number of conditions are reported to be associated with non-traumatic adrenal haemorrhage as mentioned previously (3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Recognition of these existing predisposing factors (in particular anticoagulant use) may help determine the initial management plan in this group of patients.…”

Section: Discussionmentioning

confidence: 92%

“…Five (45.5%) patients underwent definitive surgical treatment after a median [range] of 10 [7][8][9][10][11] weeks. One patient who underwent surgery and another patient managed conservatively died of disseminated non-adrenal malignant disease at 5 and 2 months respectively after presentation with bleeding.…”

Section: Resultsmentioning

confidence: 99%

“…Initial conservative management has now replaced the trend of early surgery in early years due to increasing availability of CT scan (31). In patients with evidence of persistent bleeding and hemodynamic instability despite supportive care, angioembolisation has been used with good results in the acute setting (8,24). In the presented case series, angioembolisation was done in one patient and two patients required aspiration and drainage for infected hematoma soon after the acute episode.…”

Section: Discussionmentioning

confidence: 99%

“…CT scan may be performed during follow-up to monitor the size of the haematoma and evaluate any underlying lesion (22). Other options of treatment reported are urgent surgical resection (23) and angioembolisation of the adrenal arteries (8,23,24). However, both emergency treatments were reserved in patients with hemodynamic instability.…”

Section: Original Articlementioning

confidence: 99%

“…Non-traumatic adrenal haemorrhage has been reported in association with underlying stress like sepsis, pregnancy, and after abdominal surgery (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). During this period, there is a surge of circulating catecholamines and adrenocorticotrophic hormone (ACTH) that leads to vasoconstriction of the draining venules (15).…”

Section: Introductionmentioning

confidence: 99%

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Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

Ali¹,

Singh²,

Balasubramanian³

2018

Gland Surg

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Background: Acute adrenal haemorrhage is a rare medical emergency. The aim of the series was to study the clinical presentation and management of patients presenting with acute non-traumatic adrenal haemorrhage. Methods: The records of patients presenting with an acute abdomen secondary to adrenal haemorrhage and treated in a tertiary endocrine surgical unit over a period of 6 years were reviewed. Results: Of the 11 included patients, there were 4 males and 7 females; the median [range] age at presentation was 58 [27-89] years. All were initially managed conservatively for bleeding, except one who underwent angioembolisation to ensure hemodynamic stability. Two patients underwent percutaneous drainage of persistent collection and suspected sepsis. Biochemical workup showed hyper function with metanephrine excess in 1 patient. Adrenalectomy was performed in 5 patients after a median [range] of 10 [7-11] weeks. Histology showed benign pathology in 2 patients, malignant in 2 patients and necrotic tumour in 1 patient. Two patients died of disseminated metastatic disease at 5 and 2 months after presentation with bleeding. Conservative management in the other 3 patients was successful at a median follow up of 26 [6-66] months. Conclusions: Acute adrenal haemorrhage is usually associated with an underlying pathology; which may be benign or malignant; functional or non-functional. Initial conservative management is preferred as it allows determination of functional status and elective surgery, if necessary.

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Section: Discussionmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

Ali¹,

Singh²,

Balasubramanian³

2018

Gland Surg

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Maternal morbidity and mortality associated with retroperitoneal haematomas in pregnancy

Rafi

Khalil

2018

JRSM Open

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Retroperitoneal haematomas in obstetrics are uncommon. The causes and pathogenesis of retroperitoneal haematomas lack clarity and the aim of this review is to recognise retroperitoneal haematomas as a separate entity from commonly seen vaginal and pelvic haematomas. It is time to raise awareness among obstetricians to recognise retroperitoneal haematomas as an important cause of maternal morbidity and mortality which requires high clinical suspicion and multidisciplinary input. As retroperitoneal haematomas are rare but can cause serious threat to maternal wellbeing, resources should be directed towards their management. Existing guidelines of maternal collapse and morbidity during pregnancy and puerperium need to include retroperitoneal haematomas as one of the important causes of maternal shock or morbidity. New learning pathways should be opted for to increase awareness of retroperitoneal haematomas among obstetricians enabling them to reflect on their implications while managing retroperitoneal haematomas. Management of retroperitoneal haematomas is complex and continues to improve with advancements in the investigative strategies, treatment options and multidisciplinary involvement.

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Acute Nonhemorrhagic Adrenal Infarction in Pregnancy: 10-Year MRI Incidence and Patient Outcomes at a Single Institution

Glomski

Guenette

Landman

et al. 2018

American Journal of Roentgenology

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Spontaneous Adrenal Hemorrhage in Pregnancy Presenting as a Pulmonary Embolism

Cited by 3 publications

References 4 publications

Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

Acute non-traumatic adrenal haemorrhage—management, pathology and clinical outcomes

Maternal morbidity and mortality associated with retroperitoneal haematomas in pregnancy

Acute Nonhemorrhagic Adrenal Infarction in Pregnancy: 10-Year MRI Incidence and Patient Outcomes at a Single Institution

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