Neonatal Adrenal Hemorrhage Research Articles

Bilateral adrenal hemorrhage and severe anemia in a neonate.

Neonatal adrenal hemorrhage (NAH) occurs in up to 3% of infants and is the most common adrenal mass in newborns. The most common presentation of NAH is an asymptomatic palpable flank mass which resolves over time without intervention. In rare cases, NAH can present as hemorrhage, shock, or adrenal insufficiency. This case describes a preterm infant born with severe anemia in the setting of bilateral adrenal hemorrhages with resulting adrenal insufficiency. The infant was successfully treated with blood transfusions and steroids. This is a unique presentation of NAH as it was bilateral, presented with severe anemia, and resulted in prolonged adrenal insufficiency. Consider adrenal hemorrhage for cases of severe anemia at birth. Adrenal insufficiency is a rare complication of adrenal hemorrhage. Adrenal recovery can take months, if not years.

Adrenal haemorrhage in new born presenting as severe neonatal jaundice

Neonatal adrenal haemorrhage is a relatively uncommon. Most often associated with difficult labour, birth trauma, hypoxia, sepsis. Clinical manifestations may vary from asymptomatic to life threatening Addisonian crisis. We present a case of right subacute adrenal hematoma confirmed on MRI abdomen. Risk factor being birth asphyxia. He presented with neonatal jaundice and was managed successfully by conservative methods. Treatment depends on the clinical features and severity. Most of the cases are asymptomatic and managed conservatively. Infants with acute haemorrhage might need urgent blood transfusion. Laparotomy is indicated when haemorrhage seems to be continuing, especially when the exact site of haemorrhage is in doubt. Adrenal haemorrhage usually takes 3 weeks to 6 months to resolve completely. Our case was clinically and hemodynamically stable, so he was managed conservatively and discharged after a week. This case emphasizes the importance high degree of suspicion in evaluation of neonate presented with late onset jaundice and importance of ultrasonography in diagnosis and conservative management.

Adrenal abscess as a complication of neonatal adrenal hemorrhage

Neonatal adrenal abscess is a rare condition. We present a case of a neonate with a right adrenal abscess successfully treated conservatively by an ultrasound-guided percutaneous drainage combined with broad-spectrum antibiotics. Neonates with adrenal abscess usually present with unspecific symptoms leading to frequent delay in diagnosis. The accurate diagnosis of this condition is mandatory to exclude a neuroblastoma which requires totally different care. This case report emphasizes on the differential diagnosis and the conservative management of neonatal adrenal abscess.

Adrenal gland hematoma presenting as an acute scrotum in a neonate

The acute scrotum in a neonatal patients is an emergency. Its'etiology is variable, mostly represented by testicular torsion, trauma or adrenal hemorrhage. Previously, immediate scrotal exploration was considered imperative for diagnosis and treatment. With good imaging studies, some patients are conservatively managed. We report two cases of neonatal adrenal hemorrhage presenting as acute scrotum misguiding the clinician to rule out a local scrotal pathology. As the clinical examination is not reliable in a new-born, it definitely requires an imaging evaluation to establish the diagnosis. This case report tries to outline the importance of the correlation between acute adrenal hemorrhage and acute scrotum and the role of ultrasonography as a useful tool for differential diagnosis. A well performed ultrasound examination helps to identify an abdominal pathology as the cause of an acute scrotum and to specifically diagnose an adrenal hemorrhage in order to avoid unnecessary surgical exploration.

Bilateral Neonatal Adrenal Hemorrhage Associated With Severe Maternal COVID-19 Infection

Adrenal hemorrhage is the most common cause of adrenal mass in newborns. We present a case of a full-term male, born by cesarean section due to acute fetal distress from a mother with severe coronavirus disease 2019 (COVID-19) infection. He was diagnosed with hypoxic-ischemic encephalopathy, multifactorial shock, and early neonatal sepsis. On the seventh day of hospitalization, hemoglobin dropped and thus blood transfusion was required, and abdominal ultrasound showed bilateral adrenal hemorrhage. He developed relative adrenal insufficiency without either hemodynamic instability or electrolyte imbalances. The use of parenteral corticosteroids was not required. Follow-up ultrasonography and adrenal axis laboratory examination revealed complete resolution of adrenal hemorrhage. Neonatal adrenal hemorrhage has a wide variety of clinical manifestations. Ultrasound is preferred for both initial screening and follow-up evaluation. Adrenal insufficiency occurs rarely in neonatal adrenal hemorrhage. Treatment is usually conservative. We emphasize the importance of a timely diagnosis and clinical follow-up of adrenal hemorrhage in neonates with fetal distress born from mothers with severe COVID-19.

Hematoma escrotal como signo infrecuente de hemorragia suprarrenal en recién nacidos

Antecedentes: El hematoma escrotal es una manifestación rara de hemorragia suprarrenal neonatal (0.2% de los recién nacidos). Se asocia comúnmente a la hipoxia perinatal, pero puede suceder de manera espontánea en pacientes sin patología aparente. La aparición de este signo se explica por la llegada al escroto de la sangre del lecho suprarrenal a través del canal inguinal. Resumen del caso: Varón de 24 horas de vida, nacido a término, con un peso adecuado para la edad gestacional, presenta hematoma y aumento de tamaño del hemiescroto derecho. La ecografía doppler descarta torsión testicular, identificando una estructura compatible con hematocele. La ecografía abdominal mostró signos sugestivos de hemorragia suprarrenal derecha. Se decide manejo conservador y seguimiento con pruebas de imagen, evolucionando favorablemente hacia la remisión. Conclusiones: Destacamos la importancia de incluir la hemorragia de la glándula suprarrenal en el diagnóstico diferencial de escroto agudo, ya que su detección mediante ultrasonidos puede evitar la cirugía innecesaria en el recién nacido

Neonatal Adrenal Hemorrhage Presenting As Late Onset Adrenal Insufficiency: A Case Report

Neonatal Adrenal Hemorrhage Presenting As Late Onset Adrenal Insufficiency: A Case Report

Adrenal hemorrhage in newborn: how, when and why- from case report to literature review

BackgroundNeonatal adrenal hemorrhage is a relatively uncommon condition (0.2–0.55%). Various risk factors have been reported in addition to birth asphyxia, such as sepsis, coagulation disorders, traumatic delivery, and perinatal injuries. Adrenal hemorrhage usually affects the right adrenal gland (about 70% of cases) while it involves the bilateral adrenal gland only in 10% of cases. In most cases, the event is asymptomatic but, in others, it may be so devastating to determine death by bleeding or adrenal insufficiency.Case presentationA case of bilateral neonatal adrenal hemorrhage, with adrenal insufficiency, but with no important risk factors and favorable evolution in a male infant.ConclusionsThis case emphasizes the importance of keeping a non-interventional attitude, avoiding early surgery but carrying out a serial sonographic follow-up. Serial ultrasound monitoring is the most reliable approach during conservative management.

Neonatal adrenal hemorrhage presenting as “Acute Scrotum”-looking beyond the obvious: a sonographic insight

Acute swelling and discoloration of scrotum in new born can have many localized causes like testicular torsion, inguinal hernia, scrotal or testicular edema, hydrocele, or even remote causes like adrenal hemorrhage. We report a neonate of adrenal hemorrhage presenting clinically as acute scrotum misguiding the clinician to rule out a local scrotal pathology. As the local clinical examination is not reliable in a newborn, it definitely requires an imaging evaluation to establish the diagnosis. This case report emphasizes being aware of the clinical association of acute adrenal hemorrhage and an acute scrotum and the role of ultrasonography in the evaluation of the various differential diagnoses leading to an acute scrotum. An optimum sonographic examination helps in suspecting an abdominal pathology as a cause of acute scrotum and in establishing the specific diagnosis of adrenal hemorrhage to avoid an unnecessary surgical exploration.

Neonatal Adrenal Hemorrhage presenting as Prolonged Hyperbilirubinemia

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Neonatal Adrenal Hemorrhage presenting as Prolonged Hyperbilirubinemia.

Adrenal hemorrhage is quiet uncommon in neonates with reported incidence of 0.2%-0.55% [1]. In neonates, adrenal glands are large in size and have abundant vascular supply, so more prone to hemorrhage. Clinical manifestations may vary from relatively benign as anemia, flank mass, discoloration of scrotum, neonatal jaundice to life threatening addisonian crisis depending upon the extent of hemorrhage [1]. Incidences of hemorrhage are more after prolonged labor, birth trauma, birth asphyxia, large for dates babies, sepsis and coagulation disorders [2]. We are describing a case of adrenal hemorrhage who presented with prolonged jaundice.

Hemorragia suprarrenal que se manifiesta como hematoma escrotal en el recién nacido. A propósito de un caso

Neonatal adrenal hemorrhage is uncommon. It is present in 0,2% of newborns. Ten percent of the cases occur bilaterally. It can be associated with birth trauma, large birth weight, or neonatal course complicated by hypoxia and asphyxia, hypotension, or coagulopathy. Scrotal hematoma is an extremely rare manifestation of NAH. Most patients present scrotal swelling with bluish discolouration. Scrotal swelling with/without bluish discoloration in newborns may result from different causes. We report an unusual case of neonatal adrenal hemorrhage secondary to perinatal asphyxia, associated with SH. Neonatal adrenal hemorrhage and scrotal hematoma were diagnosed by ultrasonography and treated by conservative treatment, avoiding unnecessary surgical exploration.

Adrenal haemorrhage in term neonates: a retrospective study from the period 2001–2013

Objective: To assess the incidence, risk factors and clinical presentations of neonatal adrenal haemorrhage (NAH) in uncomplicated, singleton and term deliveries. Methods: A retrospective analysis of 26 416 term neonates delivered between 2001 and 2013, and screened with abdominal ultrasonography. Results: Of the 26 416 neonates, 74 (0.28%) displayed NAH; the male/female ratio was 1.55:1. Vaginal delivery was significantly more frequent than caesarean section among them (71 versus 3; 95.9% versus 4.1%). Unilateral bleeding occurred on the right side in 36 (48.7%), and on the left in 34 (45.9%), without a significant difference; bilateral haematomas were found in four cases (5.4%). The most common risk factors were macrosomia (16, 21.6%) and fetal acidaemia (23, 31%), while four (5.4%) neonates exhibited pathological acidaemia. Clinical presentations included jaundice in 37 (50%), anaemia in six (8.1%) and an adrenal insufficiency in only one (1.3%) case. In three cases, neuroblastoma was diagnosed. Conclusions: Vaginal delivery, macrosomia and fetal acidaemia are the most important risk factors for NAH. The adrenal glands on both sides were similarly involved. In the healthy neonates with NAH, the clinical presentations were mild, with spontaneous regression. Differentiation of NAH from tumours is of considerable importance.

Congenital Adrenal Hyperplasia: A Possible Risk Factor for Neonatal Adrenal Hemorrhage

Here, we describe the first case of neonatal adrenal hemorrhage (AH) complicated with congenital adrenal hyperplasia (CAH). Our findings suggest that adrenal glands that have enlarged due to CAH are more susceptible to hemorrhaging during labor, and therefore, that CAH could be a risk factor for AH. J Med Cases. 2014;5(9):486-487 doi: http://dx.doi.org/10.14740/jmc1909w

Hématome surrénalien néonatal : diversité des modes de révélation

Neonatal adrenal hematoma is a rare condition, most frequently caused by trauma. We report three cases of adrenal hematoma admitted to the Neonatology and Neonatal Intensive Care Unit in the A. Harouchi Children's Hospital, the Ibn Rushd University Hospital in Casablanca, Morocco, over a 2-year period from January 2011 to December 2012. The average age of these patients was 5 days. The clinical presentations were diverse; the most common manifestations were intense jaundice in one case, acute adrenal insufficiency in one case, and severe anemia in the other case. Abdominal ultrasonography was used to confirm the diagnosis and monitor adrenal hemorrhage in all the patients. Analysis of clinical, laboratory, and ultrasonography data showed a favorable prognosis in all the patients. Based on these observations, we discuss the risk factors, clinical presentations, progression and management of neonatal adrenal hemorrhage.

Congenital Adrenal Hyperplasia: A Possible Risk Factor for Neonatal Adrenal Hemorrhage

Here, we describe the first case of neonatal adrenal hemorrhage (AH) complicated with congenital adrenal hyperplasia (CAH). Our findings suggest that adrenal glands that have enlarged due to CAH are more susceptible to hemorrhaging during labor, and therefore, that CAH could be a risk factor for AH. J Med Cases. 2014;5(9):486-487 doi: http://dx.doi.org/10.14740/jmc1909w

Two cases of neonatal adrenal hemorrhage presenting with persistent jaundice

The adrenal hemorrhage is a relatively rare event in newborns but must be considered in the presence of a persistent unexplained jaundice, especially in presence of predisposing factors. Serial ultrasonography is the modality of choice for initial diagnosis and follow-up of neonatal adrenal hemorrhage. We report two cases of neonatal adrenal hemorrhage presenting with persistent jaundice. The causes of the neonatal adrenal hemorrhages were a difficult vaginal delivery in macrosomic infant and a neonatal infection.

Neonatal adrenal hemorrhage presenting as acute scrotum

Neonatal adrenal hemorrhage may rarely present as acute scrotum, mimicking the conditions that require an immediate operative intervention. The authors report one such case and discuss the importance of clinical examination and ultrasonography to avoid an unnecessary surgical exploration. Keywords : neonatal acute scrotum, neonatal adrenal hemorrhage, scrotal hematoma, testicular torsion

Adrenal Hemorrhage as a Rare Cause of Neonatal Anemia Associated with Hydrocephalus Secondary to Intraventricular Hemorrhage—A Case Report

Neonatal adrenal hemorrhage is frequently associated with birth trauma, perinatal asphyxia, intrauterine infection, coagulation defects and thromboembolism. It has varied clinical presentation depending on degree of hemorrhage and amount of adrenal cortex compromised by hemorrhage. The most common clinical presentations are persistent jaundice and flank mass. We report a case of left sided adrenal hemorrhage in a breech delivered male neonate with perinatal asphyxia presented with anemia and fever. On further evaluation, he was also having moderate communicating hydrocephalus secondary to intraventricular hemorrhage. The adrenal hemorrhage was managed conservatively. Subsequent abdominal ultrasound showed resolving adrenal hemorrhage. Right ventriculoperitoneal shunt was done for hydrocephalus. Postoperative course was uneventful. The patient is asymptomatic at follow-up.

Neonatal Adrenal Hemorrhage Associated with Scrotal Hematoma: An Unusual Case Report and Literature Review

Neonatal adrenal hemorrhage (NAH) is rare and is found in only 0.2% of newborns. Scrotal hematoma (SH) in newborns is also rare. NAH associated with SH is extremely rare, with only 29 cases reported in the literature. Herein, we report a baby boy who presented with SH; after ultrasonography examinations, the diagnosis of NAH associated with SH was made. He received conservative treatment only. From our experience and that of others, appropriate integration of clinical information, physical examination and the results of abdominal and scrotal ultrasonography can achieve the accurate diagnosis of NAH associated with SH. This association allows conservative treatment that avoids unnecessary surgical exploration.