Neonatal bilateral adrenal hemorrhage: case presentation

Abstract

Adrenal hemorrhage is a relatively uncommon condition (0.2%–0.55%) during the neonatal period that may lead to acute adrenal crisis, shock, and death, unless promptly recognized and treated appropriately. The precarious blood supply of the adrenal gland makes it vulnerable to hemorrhage. The differential diagnosis includes multicystic kidney, hydronephrosis, neuroblastoma and
nephroblastoma. The cause of adrenal hemorrhage has been associated with traumatic birth and hypoxia, shock, septicemia, and intravascular coagulation The clinical features may include anemia, jaundice, abdominal mass, painful swelling with bluish discoloration of the scrotum, acute adrenal crisis or shock. The large majority of patients with adrenal hemorrhage do not have clinically obvious signs of adrenal insufficiency. The diagnosis is usually made incidentally at imaging performed for another reason. Since patients with unilateral or bilateral adrenal hemorrhages are usually treated conservatively, noninvasive diagnostic techniques are preferable. This report presents a case of neonatal bilateral adrenal hemorrhages diagnosed ultrasonographically.