Adrenal haemorrhage in the new born: revisited

Abstract

Background: Adrenal haemorrhage (AH) in the new-born is not that uncommon and has been reported frequently. AH occurs most often after a traumatic delivery or complicated neonatal course. Design and setting: A retrospective, hospital-based study conducted at king Khalid university hospital (KKUH), endocrine service, Riyadh, Saudi Arabia, during the period January 2014 and July 2018. Methods: Medical records of neonates who had been diagnosed to have AH were reviewed. Data included age, sex, clinical manifestations, laboratory and radiological investigations. Results: During the period under review, five neonates were diagnosed to have adrenal haemorrhage. All were term male infants, who were delivered vaginally .one baby was large for gestational age (LGA), and three babies had perinatal hypoxemia. Clinical symptoms were not specific and diagnosis was confirmed by performing abdominal sonography (USG). Conclusion: AH should be recognised in the new-borns with nonspecific symptoms who had potential risk factors. Abdominal ultrasonography (USG) should be performed to diagnose AH, and monitor its progress. Adrenal hormone testing also should be performed.

Management of Neonatal Adrenal Masses: A Single Center Experience: A Retrospective Study

“…Neonatal adrenal hemorrhage (NAH) is most common in term babies born vaginally and mostly affects males. 1,7 In this study, NAH was observed more frequently in term babies born vaginally, in line with the literature. On the contrary, our female cases were more common with a rate of 57%.…”

“…Jaundice, signs of ischemia, palpable abdominal mass and anemia may be detected. 1,7,10,11 by the breakdown of red blood cells, is the most common presentation. 7 Adrenal insufficiency rarely occurs, usually in the first postnatal week.…”

“…1,7,10,11 by the breakdown of red blood cells, is the most common presentation. 7 Adrenal insufficiency rarely occurs, usually in the first postnatal week. Jaundice requiring phototherapy was present in 45% of the cases in this study, and anemia was detected in 16%.…”

“…With serial US/Doppler US, it is possible to demonstrate resolution of adrenal hemorrhage, but persistence, enlargement or change in nature of the mass may indicate neuroblastoma or another pathology. 7 Sometimes a complex situation may occur due to the combination of necrotic tissue, blood clot, calcification and cyst. Calcification can be seen after the resolution of the hemorrhage, 1-2 weeks after the onset.…”

“…While hypertension may occur due to mass compression, hypotension may occur due to adrenal insufficiency. 7 Although hypertension is expected mostly in neuroblastoma cases, hypertension may be seen secondary to pushing or compression of renal arteries and veins in large surrenal hemorrhages. 7,14 The mean blood pressure of our patients at the time of hospitalization was 77.6/44.4 mmHg (99-54/70-36) and was compatible with their age.…”