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

Abstract

Adrenal hemorrhage in newborns is a rare condition with a frequency of 0.2-0.55%. Various risk factors have been reported besides asphyxia resulting from sepsis, coagulation disorders and traumatic delivery. In this study, we aimed to evaluate the results of our neonatal cases who were followed-up and treated due to adrenal hemorrhage/mass. Material and Methods: Patients followed-up(neuroblastoma follow-up protocol)/operated due to adrenal mass between 2007-2021 were retrospectively analyzed. Gender, diagnosis age-type, laterality data, laboratory-ultrasound(US) findings were recorded and examined. Results: Along 14 years, two patients with bilateral renal hypoplasia of 44 patients who were evaluated with the preliminary diagnosis of adrenal mass were excluded, so 42 patients were included. Eighteen (42.9%) patients were male, 24 (57.1%) were female, 7 were antenatally-diagnosed, mean age of diagnosis was 11 days in those diagnosed-postnatally. 23 had right, 13 had left, and 6 had bilateral surrenal masses. 38 were cystic, 7 were semisolid, 3 were solid. On the first US, the mean mass size was 34x23mm-the mean mass volume was 12mL. The mean mass size was 31x19mm-the mean mass volume was 8mL in the third month. Urine vanilla mandelic acid levels were normal in all patients. In follow-up, three patients were operated because they had solid lesion size over 16mL. One of them underwent pyeloplasty due to ureteropelvic junction obstruction, two had bening pathology. Conclusion: Differential diagnosis between neonatal neuroblastoma and adrenal hemorrhage can be difficult. Follow-up with US-Doppler US and tumor markers is useful and the most reliable method in distinguishing neuroblastoma and adrenal hemorrhage.