Unilateral Spontaneous Adrenal Haemorrhage in Pregnancy

Abstract

Spontaneous Adrenal Haemorrhage (SAH) is a rare condition in which there is haemorrhage in the adrenal gland without any adrenal tumour or history of trauma. It presents as severe flank pain with or without shock depending on the amount of haemorrhage. The initial investigation of choice is ultrasound and the diagnosis can be confirmed by computed tomography or magnetic resonance imaging We report the case of a pregnant female, presenting with left flank pain and high blood pressure, in the late third trimester. Ultrasonography revealed intra-uterine fetal demise with a large left suprarenal mass. Subsequent imaging by computed tomography and magnetic resonance imaging revealed a heterogeneous left adrenal mass with imaging features suggestive of haemorrhage. The patient delivered spontaneously and her blood pressure returned to normal spontaneously. She was explained about the entity as well as the risks and benefits of surgery for this condition. She did not want to undergo surgery and decided to be on regular follow-up. We repeated the ultrasound every 2 weeks, which showed no increase in the size of the lesion. The patient was asked to continue monthly follow-up for 3 months followed by 3-monthly follow-up by ultrasonography. This case reiterates the fact that obstetricians should keep a highindex of suspicion for this rare condition after ruling out more common causes of flank pain in pregnancy, and should suspect SAH especially if there is associated severe anemia or shock. The knowledge of this rare entity can help in correct diagnosis and early appropriate treatment.