Adrenal hematoma simulating tumor in a newborn; report of a case and review of the literature.

Abstract

ASPHYXIA at birth or trauma during and after delivery (prolonged labor, breech presentation, aggressive resuscitation maneuver, etc.) may precipitate adrenal hemorrhage in newborn infants. Local and general factors may facilitate this occurrence. The adrenal gland is large and extremely vascular at birth, and the inner cortex presents marked congestion with fatty and some necrotic changes.1Also, adrenal hemorrhage occurs more frequently between the second and the seventh postnatal days, when hypoprothrombinemia and increased vascular fragility are particularly pronounced. Bilateral adrenal hemorrhage in the newborn infant is followed by a series of symptoms which have been well defined by Magnus2and by Goldzieher and Gordon.3Symptoms include those due to adrenal insufficiency and shock as well as hemorrhage within the gland (palpable retroperitoneal mass). If the hemorrhage is unilateral, symptoms of adrenal insufficiency and shock are less severe, and later, when the newborn infant recovers from the acute