Neonatal Adrenal Hemorrhage

• Published in: Applied radiology (1976) Vol. 53; no. 1; pp. 48 - 48f
• Main Authors: Tolson, Hanna, Towbin, Richard B, Schaefer, Carrie M, Towbin, Alexander J
• Format: Journal Article
• Language: English
• Published: Scotch Plains Anderson Publishing Ltd 01-01-2024
• Subjects: Abdomen; Adrenal glands; Anemia; Asphyxia; Asymptomatic; Bleeding; Calcification; Discoloration; Hemorrhage; Hypotension; Hypotonia; Infants (Newborn); Lethargy; Neuroblastoma; Peritoneum; Risk factors; Ultrasonic imaging
• ISSN: 1879-2898; 0160-9963; 1879-2898
• DOI: 10.37549/AR2954

The differential diagnosis for a suprarenal mass in a neonate includes neuroblastoma, mesoblastic nephroma, and subdiaphragmatic extralobar pulmonary sequestration1 risk factors and clinical presentations of neonatal adrenal haemorrhage (NAH Discussion Adrenal hemorrhage is a relatively uncommon condition in neonates, occurring injust 0.2-0.55% of live births.1 The vascular architecture of the adrenal gland is unique and particularly vulnerable to arteriolar rupture and bleeding. Neonates are at risk for adrenal hemorrhage owing to the relatively large size of their adrenal glands and their resultant increased vascularity.4 Other factors that increase the risk of hemorrhage in neonates include the hormone release during the antenatal period and changing pressures as the neonate passes through the vaginal canal.5 Though some risk factors for adrenal hemorrhage have been reported, the etiology of bleeding in many cases remains unknown. [...]acidemia, asphyxia, septicemia, prolonged labor, hypotension, and difficult delivery all increase the risk of adrenal hemorrhage.5 Additionally, male gender and macrosomia have been identified as risk factors, likely owing to increased size of the newborn and potential for stress during delivery.6 The presentation of neonatal adrenal hemorrhage is variable and nonspecific. Other common features include anemia, pallor, flank mass, and lethargy/hypotonia.1 Scrotal discoloration has been reported, with an incidence of about 0.2%, and occurs either by dissection along the tissue planes of the retroperitoneum outside the processus vaginalis or by rupture of the posterior peritoneum, resulting in intraperitoneal hemorrhage and descending within the patent processes vaginalis.5 As the adrenal gland has significant regenerative capacity, hemorrhage is typically not associated with adrenal insufficiency.4 Abdominal ultrasound generally serves as the initial diagnostic modality.