Neonatal adrenal hemorrhage. Diagnostic considerations and clinical attitude

Abstract

Three cases diagnosed at our Service of unilateral adrenal hemorrhage are presented. The diagnosis was at neonatal period in two cases and the third case should be suspected later by abdominal radiography revealed an adrenal calcifications. The first and second newborn was admitted to hospital by jaundice and the abdominal examination revealed a palpable mass in the first. Both cases are men. Families? histories were no pertinent; they have been born at term after a normal pregnancy. The childbirth course was complicated by prolonged labor; it was Instrumental childbirth in the first. The neonatal period, anthropometric and laboratory studies were normal. In both children abdominal ultrasound revealed adrenal mass with anechoic areas, it is suggesting adrenal hemorrhage. In both cases was conservative man-agement, and clinical observation in the appearance of signs of adrenal insufficiency (hypotension, hypoglycemia, hyperkaliema, hyponatremia, acidose, convulsions, and comma), massive hemorrhage or signs of surgical indication. The hormonal determination, levels electrolytes blond and urine were normal. Both young they remain asymptomatic, treatment was phototherapy and serial ultrasounds. Follow up ultrasound is needed for diagnosis and differential diagnosis with neuroblastoma, cortical cyst or adrenal abscess. A third case the diagnosis was made later incidentally, suggestive adrenal calcifications of old adrenal hemorrhage. He was 8 years old boy. He was admitted to hospital by jaundice at newborn period.