Spontaneous Adrenal Hemorrhage in Pregnancy: A Case Series

Gupta, Ankita; Minhas, Ruby; Quant, Hayley S.

doi:10.1155/2017/3167273

Cited by 10 publications

(31 citation statements)

References 7 publications

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“…Although pregnancy is a known risk factor for adrenal haemorrhage (10,11), the risk is unclear (28). It may occur without additional factors and is reported in complicated pregnancies such as hyperemesis gravidarum and difficult labour (11,28,29). One patient in our case series had history of post-partum haemorrhage 15 weeks before presentation.…”

Section: Discussionmentioning

confidence: 84%

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: 84%

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

Ali¹,

Singh²,

Balasubramanian³

2018

Gland Surg

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“…We reviewed 5 case reports [8] , [9] , [10] , [11] , [12] and a case series (with 2 cases) [13] for SAH in pregnancy. Most of these presented in third trimester.…”

Section: Discussionmentioning

confidence: 99%

“…Arterial embolization of adrenals may be needed as a bridging therapy for subsequent surgery in severe hemorrhage cases. In our reviewed 7 case reports [8] , [9] , [10] , [11] , [12] , [13] , all the cases were managed conservatively; none required surgery for adrenal hemorrhage. The cases with adrenal insufficiency were managed with steroids.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic unilateral adrenal hemorrhage in a term pregnant primigravida female

Singh

Sinha

Singh

2020

Radiology Case Reports

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Idiopathic or spontaneous adrenal hemorrhage is a rare entity and a serious medical condition which is usually underestimated but can result in multiorgan failure, hemodynamic instability and death. It is usually diagnosed postmortem, as it has a nonspecific presentation in view of some other concurrent illness. Pregnancy-induced adrenal hemorrhage in itself is quite rare and a poorly understood disorder. We report here a case of 24-year-old primigravida female at 38 + 6 weeks of gestation who presented with right loin pain associated with fever and chills. Abdominal ultrasound and magnetic resonance imaging were performed which revealed presence of hematoma in right suprarenal location. A diagnosis of idiopathic right adrenal hemorrhage was made. The patient was managed conservatively and was stable post delivery. As this condition can have complications which can potentially be life-threatening, clinicians should keep a high suspicion for this disease when a pregnant female presents with acute abdominal pain.

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“…Surgical, conservative, and interventional treatments are the main management of spontaneous adrenal hemorrhage in pregnancy, which depends upon the week of gestation, amount of bleeding, imaging findings, adrenal function, and so on. [6–9] It is difficult to form a systematic evaluation system for this condition because lack of high evidence studies. Keizer et al [6] put forward if the bleeding is less severe and the patient is hemodynamically stable, conservative management can be appropriate during pregnancy, since their patients achieved good therapeutic effects by just surveillance.…”

Section: Discussionmentioning

confidence: 99%

“…Keizer et al [6] put forward if the bleeding is less severe and the patient is hemodynamically stable, conservative management can be appropriate during pregnancy, since their patients achieved good therapeutic effects by just surveillance. [8,9] While Anagnostopoulos and Sharma [1] reported another case of retroperitoneal hematoma secondary to right adrenal hemorrhage and managed by laparotomy drainage and packing of the retroperitoneal hematoma. The laparoscopic approach performed in this case is based on the unconfirmed diagnosis, risk of rehemorrhagia, and relieving of anxiety.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous adrenal hematoma in pregnancy

Yang¹,

Zhu

Liu³

2018

Medicine

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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.

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Spontaneous Adrenal Hemorrhage in Pregnancy: A Case Series

Cited by 10 publications

References 7 publications

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

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

Idiopathic unilateral adrenal hemorrhage in a term pregnant primigravida female

Spontaneous adrenal hematoma in pregnancy

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