Spontaneous Adrenal Hematoma During Pregnancy: A Case Report

Abdominal pain is a common complaint during pregnancy and may be attributed to a broad spectrum of underlying causes—one of the rarer but serious possibilities being spontaneous adrenal hemorrhage (SAH). While post-mortem studies have reported adrenal hemorrhage in 0.03% to 1.8% of unselected cases, its true incidence during pregnancy remains unclear.

We report the case of a 27-year-old woman who presented with abdominal pain. Imaging revealed a left adrenal lesion, leading to a decision for left adrenalectomy. Histopathology confirmed the diagnosis of adrenal hematoma.

Pregnancy-specific physiological changes predispose women to adrenal hemorrhage. These include increased arterial supply to the adrenal glands with relatively limited venous drainage, adrenal cortex hyperplasia, and a hypercoagulable state. Importantly, SAH can occur even in the absence of common predisposing factors such as trauma, recent surgery, coagulopathy, or adrenal neoplasms.

Diagnosing adrenal hematoma preoperatively remains a clinical challenge. In most cases, the diagnosis is made intraoperatively or on histological examination post-surgery.

Reference:

Gupta R, Tayal N, Ramu G. Indian J Obstet Gynecol Res. 2023