{
  "abstract": "Spontaneous adrenal haemorrhage (SAH) during pregnancy is rare. Its incidence is unknown. A maternal mortality rate of 15% has been reported. 1 The exact pathophysiology of SAH is uncertain with several hypotheses proposed. SAH has been reported in association with underlying stressful events such as pregnancy,2 3 thromboembolic disease and sepsis. The adrenal glands have a rich blood supply via three main arteries with slow venous drainage via the adrenal vein only. The abrupt transition from the artery to capillary complex creates a ‘vascular dam’. Therefore, any increase in arterial flow or venous pressure can lead to intraglandular vascular congestion and thereby haemorrhage.1 4 During physiological stress, a surge in catecholamines, adrenocorticotropic hormone (ACTH) and cortisol leads to vasoconstriction of the draining venules5 and platelet aggregation,4 increasing adrenal venous pressure resulting in SAH. During pregnancy, physiological increase in circulating cortisol levels, placenta production of cortisol-releasing hormone and ACTH stimulate the adrenal gland causing increased adrenal vascular supply, venous pressure and hypertrophy, predisposing the adrenal gland to bleeding.2 Autopsy studies showed an increased risk of SAH in patients with pre-eclampsia.6",
  "authors": [
    {
      "affiliations": [
        "Department of Urology, East and North Hertfordshire NHS Trust, Stevenage, UK"
      ],
      "name": "Kimberley Chan"
    },
    {
      "affiliations": [
        "Department of Urology, East and North Hertfordshire NHS Trust, Stevenage, UK"
      ],
      "name": "Ben Pullar"
    },
    {
      "affiliations": [
        "Department of Urology, East and North Hertfordshire NHS Trust, Stevenage, UK"
      ],
      "name": "James Adshead"
    },
    {
      "affiliations": [
        "Department of Urology, East and North Hertfordshire NHS Trust, Stevenage, UK"
      ],
      "name": "Andrew Brodie"
    }
  ],
  "title": "Spontaneous adrenal haemorrhage during pregnancy: a case report",
  "uid": "105f9b5f-5bcf-5c7b-afdb-a82fc8213c3c"
}