Adrenal haemorrhage presenting as an abdominal mass in the newborn

Abstract

Adrenal haemorrhage in the newborn, an entity well recognized at autopsy and as a cause of massive haemorrhage, may present as an asymptomatic abdominal mass. Three cases of neonatal adrenal haemorrhage are described and the literature is reviewed. Most of the affected babies were of normal birthweight, full term and with no history of difficult delivery or neonatal asphyxia. Most presented with a flank mass and jaundice. The haemoglobin was not always low. Intravenous urography and sonography were the investigations of choice. The most serious condition in the differential diagnosis is neuroblastoma, but the chance of this presenting in the newborn period with normal catecholamine secretion and no evident metastases is sufficiently rare to justify expectant management. Follow‐up physical examination and repeat sonography at 1 month are recommended. This interval is long enough to allow resolution of a mass caused by adrenal haemorrhage.

Neonatal adrenal hemorrhage presenting as late onset neonatal jaundice

“…The commonest presentation is abdominal mass. [1] Neonatal jaundice is also common. However late onset jaundice is rarely reported as the primary presentation.…”

Prenatal diagnosis of fetal adrenal masses: differentiation between hemorrhage and solid tumor by color Doppler sonography

“…Indeed, a substantial number of such masses, both cystic and solid, have turned out to be neuroblastoma, some of which were complicated by hemorrhage within the tumor 2 . Conversely, there are reports describing the spontaneous resolution of antenatally diagnosed adrenal masses 3 and hemorrhages presenting with an atypical sonographic appearance 4 . We describe four cases of prenatal adrenal masses diagnosed in utero, of which three were adrenal hemorrhages and one was a neuroblastoma, all correctly diagnosed and followed-up by sonography (color Doppler imaging).…”

Incidental Finding of Idiopathic Unilateral Adrenal Calcification in an 18-Month-Old Child: Case Report and Review of the Literature

“…A host of neonatal cases have been reported with a wide spectrum of clinical severity, from asymptomatic cystic adrenal masses to adrenal crisis deriving from liver disease 17,18 , from right scrotal swelling or left scrotal hematoma 19,20 to bilateral renal vein and vena cava thrombosis secondary to extrinsic compression by large haemorrhagic adrenal glands 21 Neonates Anemia, jaundice differential diagnosis with neuroblastoma 27 . Other groups have shown that surgery is rarely necessary both for diagnosis and treatment in neonatal cases 28,29 .…”