Background Spontaneous adrenal haemorrhage (SAH) is an acute, spontaneous haemorrhage of the adrenal gland associated with acute abdominal pain in the absence of prior trauma or anticoagulant therapy. It is a rare condition and has been reported in association with pregnancy. Physiological hypervascularity of adrenal glands during pregnancy, stress, adrenal venous thrombosis and hypertension have been suggested as predisposing factors for SAH during pregnancy.1

Case Report A 31-year-old primigravida presented at 15 weeks gestation with sudden onset back pain which failed to settle with simple analgesia. Blood tests revealed haemoglobin of 4.6 g/dl and MRI scan showed a 25cm haematoma attached to the right adrenal gland. The bleed was managed conservatively and, following 8 units blood transfusion, haemoglobin was 9.7 g/dl. Investigations for phaeochromocytoma were negative. Basic screen for possible bleeding tendency was normal. The patient remained stable throughout the pregnancy. Serial growth ultrasound scans showed satisfactory fetal growth increments. Repeat MRI scan in the third trimester showed the size of the haematoma had reduced significantly.

The patient was delivered of a male infant weighing 3350 g in December 2009 by elective caesarean section. Postoperative recovery was uneventful and mother and baby were discharged home well.

Discussion The incidence of SAH ranges from 0.14% to 1.1%. It may be unilateral or bilateral; unilateral adrenal haemorrhage usually involves the right gland.1 Adrenal haemorrhage may result in maternal death and those who survive may develop adrenal insufficiency.2 Thus it is important to consider SAH in the differential diagnosis of a symptomatic adrenal mass in pregnancy.3