Abstract
A3-day-old male infant was referred to our intensive care unit because of an abdominal mass. He was born at term by spontaneous vaginal delivery, with a birth weight of 3000 g. APGAR scores were 8 at 1 minute and 9 at 5 minutes. The physical examination revealed an active and well-looking infant. The remaining findings were unremarkable except for an abdominal flank mass noted on the left side and a mild hemihypertrophy on the left side (Figure 1). An ultrasound of the abdomen revealed bilateral, well-defined hypoechoic masses in the adrenal glands, consistent with hemorrhage. Abdominal magnetic resonance imaging (MRI) scan showed bilateral, well-defined hyperintense lesions located in the adrenal glands; the left one being bigger and compressing the left kidney inferiorly (Figure 2). A random urinary vanillylmandelic acid (VMA) level is 12.4 mcg/mg urinary creatinine (normal, 5–37 mcg/mg urinary creatinine) and random urinary homovanillic acid (HVA) is 18 mcg/mg urinary creatinine (normal, 11–35 mcg/mg urinary creatinine). Serial measurement of urinary levels of VMA and HVA were also within normal limits. The remainder tests including prothrombin time, partial thromboplastin time, factor levels, ACTH and cortisone levels were found to be in normal limits. A low-dose (1 mg) corticotropin (ACTH) test showed a significant cortisol response.
Published Version
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