Bilateral Adrenal Infarction and Secondary Haemorrhage in Pregnancy: Implications of Factor V Leiden Heterozygosity: A Review of the Literature and a Case Report.

Abstract

Adrenal haemorrhage in pregnancy is rare but can lead to significant maternal and foetal morbidity if unrecognised. We present the case of a 25-year-old woman in her second pregnancy, who was admitted at 34+4 weeks of gestation with severe abdominal pain. Despite initial unremarkable assessments, further imaging revealed a left adrenal haemorrhage, with evidence of prior right adrenal infarction, resulting in primary adrenal insufficiency. Haematological investigations later confirmed heterozygous Factor V Leiden as a likely contributing factor. This report underscores the diagnostic challenges of adrenal pathology in pregnancy, where symptoms may overlap with more common conditions. Immediate management with hydrocortisone therapy, supported by a multidisciplinary team (MDT), was employed, with a successful outcome for both mother and child following delivery by caesarean section.