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Am J Perinatol 2009; 26(8): 553-557
DOI: 10.1055/s-0029-1214239
© Thieme Medical Publishers

Adrenal Hemorrhage in a Newborn

Arebu T. Abdu1 , Vesna M. Kriss2 , Henrietta S. Bada1 , Eric W. Reynolds1
  • 1Division of Neonatology, Department of Pediatrics, University of Kentucky College of Medicine, Kentucky Children's Hospital, Lexington, Kentucky
  • 2Department of Diagnostic Radiology, University of Kentucky College of Medicine, Kentucky Children's Hospital, Lexington, Kentucky
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Publication History

Publication Date:
18 May 2009 (online)

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ABSTRACT

Sometimes in the course of care in a neonatal intensive care unit, there may be a rush to intervene in cases where limited intervention is actually the correct course. One such example is that of neonatal adrenal hemorrhage. We present the case of a male term neonate with shock, metabolic acidosis, distended abdomen, and falling hematocrit. His prenatal and delivery histories were uneventful except for a nuchal cord. Apgar scores were 9 and 9. Because of his dramatic presentation, certain members of the medical team suggested immediate surgical intervention. However, a calm and careful evaluation revealed the true diagnosis and course of action. Ultrasound of the abdomen showed a mass between the liver and kidney, but the origin was difficult to identify. A computed tomography scan supported the diagnosis of right adrenal hemorrhage. His serum cortisol level was normal. The patient was managed conservatively and discharged home after a 1-week stay in the hospital. Subsequent abdominal ultrasound showed resolving adrenal hemorrhage with minimal calcification. A review of the pertinent literature is presented. Physicians should remember adrenal hemorrhage when evaluating a newborn infant with shock, acidosis, abdominal distention, and falling hematocrit and that conservative management is usually indicated.

KEYWORDS

Adrenal hemorrhage - neonate - neonatal intensive care - abdominal mass - hypovolemia

REFERENCES

  • 1 Avolio L, Fusillo M, Ferrari G, Chiara A, Bragheri R. Neonatal adrenal hemorrhage manifesting as acute scrotum: timely diagnosis prevents unnecessary surgery.  Urology. 2002;  59 601
    PubMedSearch in Google Scholar
  • 2 Duman N, Oren H, Gulcan H, Kumral A, Olguner M, Ozkan H. Scrotal hematoma due to neonatal adrenal hemorrhage.  Pediatr Int. 2004;  46 360-362
    CrossrefPubMedSearch in Google Scholar
  • 3 Smith J A, Middleton R G. Neonatal adrenal hemorrhage.  J Urol. 1979;  122 674-677
    PubMedSearch in Google Scholar
  • 4 Jojart G, Nagy G, Pasztor J, Kovacs Z. Neonatal gland hemorrhage.  Orv Hetil. 1992;  133 1179-1181
    PubMedSearch in Google Scholar
  • 5 Spencer H. On visceral hemorrhages in stillborn children.  Transactions of the Obstetrical Society of London. 1892;  23 303
    PubMedSearch in Google Scholar
  • 6 Felc Z. Ultrasound in screening for neonatal adrenal hemorrhage.  Am J Perinatol. 1995;  12 363-366
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Mittelstaedt C A, Volberg F M, Merten D F, Brill P W. Sonographic diagnosis of neonatal adrenal hemorrhage.  Radiology. 1979;  131 453-457
    PubMedSearch in Google Scholar
  • 8 Khuri F J, Alton D J, Hardy B E, Cook G T, Churchill B M. Adrenal hemorrhage in neonates: report of 5 cases and review of the literature.  J Urol. 1980;  124 684-687
    PubMedSearch in Google Scholar
  • 9 Fang S B, Lee H C, Sheu J C, Lo Z J, Wu B L. Prenatal sonographic detection of adrenal hemorrhage confirmed by postnatal surgery.  J Clin Ultrasound. 1999;  27 206-209
    CrossrefPubMedSearch in Google Scholar
  • 10 Black J, William D I. Natural history of adrenal hemorrhage in the newborn.  Arch Dis Child. 1973;  48 183-190
    CrossrefPubMedSearch in Google Scholar
  • 11 Velaphi S C, Perlman J M. Neonatal adrenal hemorrhage: clinical and abdominal sonographic findings.  Clin Pediatr (Phila). 2001;  40 545-548
    CrossrefPubMedSearch in Google Scholar
  • 12 DeSa D J, Nicholls S. Hemorrhagic necrosis of the adrenal gland in prenatal infants: a clinico-pathological study.  J Pathol. 1972;  106 133-149
    PubMedSearch in Google Scholar
  • 13 Moore K L, Persaud T VN. Chapter 13. The urogenital system. In: The Developing Human—Clinically Oriented Embryology 5th ed. Philadelphia; W.B. Saunders Co. 1993
    Search in Google Scholar
  • 14 Goldzieher M A, Gorden M B. Syndrome of adrenal hemorrhage in the newborn.  Endocrinology. 1932;  16 165
    CrossrefPubMedSearch in Google Scholar
  • 15 Adorisio O, Mattei R, Ciardini E, Centonze N, Noccioli B. Neonatal adrenal hemorrhage mimicking an acute scrotum.  J Perinatol. 2007;  27 130-132
    CrossrefPubMedSearch in Google Scholar
  • 16 Amoury R A, Barth G W, Hall R T, Rhodes P G, Holder T M, Ashcraft K W. Scrotal ecchymosis: sign of intraperitoneal hemorrhage in the newborn.  South Med J. 1982;  75 1471-1475
    PubMedSearch in Google Scholar
  • 17 Reynolds E W, Douglass B, Bleacher J. Meconium peritonitis.  J Perinatol. 2000;  20 193-195
    CrossrefPubMedSearch in Google Scholar
  • 18 Bor O, Akgun N, Yakut A, Sarhus F, Kose S. Late hemorrhagic disease of the newborn.  Pediatr Int. 2000;  42 64-66
    CrossrefPubMedSearch in Google Scholar
  • 19 Mineau D E, Koehler P R. Ultrasound diagnosis of neonatal adrenal hemorrhage.  AJR Am J Roentgenol. 1979;  132 443-444
    PubMedSearch in Google Scholar
  • 20 Hoeffel C, Legmann P, Luton J P, Chapuis Y, Fayet-Bonnin P. Spontaneous unilateral adrenal hemorrhage: computerized tomography and magnetic resonance imaging findings in 8 cases.  J Urol. 1995;  154 1647-1651
    CrossrefPubMedSearch in Google Scholar
  • 21 Stichnoth F A, Kehr S, Baumer K. Nuclear magnetic resonance tomography in the differential diagnosis of adrenal gland hemorrhage and neuroblastoma in a newborn infant.  Monatsschr Kinderheilkd. 1990;  138 221-223
    PubMedSearch in Google Scholar
  • 22 Smoljanic Z, Zivie G, Kos R, Krstic Z. Adrenal gland hemorrhage in neonates—radiologic aspect.  Srp Arh Celok Lek. 1997;  125 295-298
    PubMedSearch in Google Scholar
  • 23 Hung F C, Huang C B. Neonatal adrenal hemorrhage. a case report.  Changgeng Yi Xue Za Zhi. 1991;  14 136-140
    PubMedSearch in Google Scholar
  • 24 Perl S, Kotz L, Keil M, Patronas N J, Stratakis C A. Calcified adrenals associated with perinatal adrenal hemorrhage and adrenal insufficiency.  J Clin Endocrinol Metab. 2007;  92 754
    PubMedSearch in Google Scholar
  • 25 Ruminska M, Welc-Dobies J et al.. Adrenal haemorrhage in neonate: risk factors, diagnosis and clinical procedure.  Med Wieku Rozwoj. 2008;  12 457-462
    PubMedSearch in Google Scholar

Arebu T AbduM.D. 

Department of Pediatrics, Division of Neonatology, University of Kentucky College of Medicine

800 Rose St. MS 477, Lexington, KY 40536

Email: abadtu2@uky.edu