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Review
. 2019 May 8;45(1):58.
doi: 10.1186/s13052-019-0651-9.

Adrenal hemorrhage in newborn: how, when and why- from case report to literature review

M S Toti  1 , P Ghirri  2 , A Bartoli  3 , C Caputo  3 , E Laudani  3 , F Masoni  3 , L Mele  3 , R Bernardini  3
Affiliations
Review

Adrenal hemorrhage in newborn: how, when and why- from case report to literature review

M S Toti et al. Ital J Pediatr. .

Abstract

Background: Neonatal adrenal hemorrhage is a relatively uncommon condition (0.2-0.55%). Various risk factors have been reported in addition to birth asphyxia, such as sepsis, coagulation disorders, traumatic delivery, and perinatal injuries. Adrenal hemorrhage usually affects the right adrenal gland (about 70% of cases) while it involves the bilateral adrenal gland only in 10% of cases. In most cases, the event is asymptomatic but, in others, it may be so devastating to determine death by bleeding or adrenal insufficiency.

Case presentation: A case of bilateral neonatal adrenal hemorrhage, with adrenal insufficiency, but with no important risk factors and favorable evolution in a male infant.

Conclusions: This case emphasizes the importance of keeping a non-interventional attitude, avoiding early surgery but carrying out a serial sonographic follow-up. Serial ultrasound monitoring is the most reliable approach during conservative management.

Keywords: Adrenal insufficiency; Differential diagnosis; Hormonal therapy; Neonatal adrenal hemorrhage; Ultrasound monitoring.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

The patient’s parent provides his consent to submission.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Differential diagnosis of suprarenal abdominal masses in newborn
Fig. 2
Fig. 2
Abdominal ultrasonography revealed suprarenal bilateral lesion, well circumscribed with an inhomogeneous aspect but without vascular flow on Color-Doppler images. The images (25 mm × 16 mm right, 30 × 16 mm left) were mostly isoechoic- hyperechoic. There was a solid portion with essentially normal kidneys and no foci of blood flow within the area
Fig. 3
Fig. 3
Evolution of the echographic aspect at 15 days of life for modification of the haemorrhagic lesion. The images were mostly isoechoic-anechoic. There was a solid portion, but also fluid level, some internal echoes and minimum turbidity with normal kidneys
Fig. 4
Fig. 4
Ultrasound changes of NAH in follow-up with modification of the ultrasonographic appearance
Fig. 5
Fig. 5
Progressive ultrasound reduction of lesions at 45 days of life (a) and at 60 days of life (b)
Fig. 6
Fig. 6
Complete regression of adrenal hemorrhage after 88 days of life with normal renal and adrenal ultrasound appearance
See this image and copyright information in PMC

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