Spontaneous Adrenal Hematoma During Pregnancy

Abdominal pain is a commonly reported issue during pregnancy and has a wide range of potential causes – one of which is spontaneous adrenal hemorrhage (SAH). While post-mortem examinations indicate adrenal hemorrhage in 0.03% to 1.8% of unselected cases, its incidence, specifically among pregnant women, remains uncertain. 

This case reports a 27-year-old lady who presented with abdominal pain. Subsequent evaluation revealed a left adrenal lesion. This prompted a left-sided adrenalectomy.

Several high-risk factors contribute to adrenal hemorrhage occurrence during pregnancy, including an elevated arterial blood supply to the adrenal gland coupled with limited venous drainage, physiological adrenal cortex hyperplasia, and an increased tendency toward hypercoagulation. These factors can lead to hemorrhage even in the absence of other precipitating factors such as – recent surgery, coagulation disorders, trauma, or an underlying adrenal mass. Of note, preoperative diagnosis of adrenal hematoma is challenging and, in most cases, the diagnosis typically occurs postoperatively.

Source: Gupta R, Tayal N, Ramu G. Indian J Obstet Gynecol Res. 2023 (Ahead of print).