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Neonatal Adrenal Hemorrhage
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Adrenal hemorrhage, adrenal cortical hematoma
            • Definitions

              • Perinatal bleeding into normal adrenal gland
              • Associated with many perinatal stressors
                • Asphyxia, sepsis, birth trauma, coagulopathies

            IMAGING

            • General Features

              • Radiographic Findings

                • Ultrasonographic Findings

                  • CT Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Birkemeier KL: Imaging of solid congenital abdominal masses: a review of the literature and practical approach to image interpretation. Pediatr Radiol. 50(13):1907-20, 2020
                                            2. Schwab ME et al: Imaging modalities and management of prenatally diagnosed suprarenal masses: an updated literature review and the experience at a high volume Fetal Treatment Center. J Matern Fetal Neonatal Med. 1-8, 2020
                                            3. Tognato E et al: Neonatal adrenal hemorrhage: a case series. Am J Perinatol. 37(S 02):S57-60, 2020
                                            4. Alonso V et al: Conservative management of scrotal hematoma secondary to adrenal hemorrhage in newborns. Urology. 133:e1-2, 2019
                                            5. Angelis D et al: Neonatal adrenal findings: significance and diagnostic approach. Description of two cases. Clin Case Rep. 6(4):658-63, 2018
                                            6. Wang L et al: Clinical value of serial ultrasonography in the dynamic observation of foetal cystic adrenal lesions. Prenat Diagn. 38(11):829-34, 2018
                                            7. Zessis NR et al: Severe bilateral adrenal hemorrhages in a newborn complicated by persistent adrenal insufficiency. Endocrinol Diabetes Metab Case Rep. 2018:17-0165, 2018
                                            8. Bhatt S et al: Neonatal adrenal hemorrhage presenting as "acute scrotum"-looking beyond the obvious: a sonographic insight. J Ultrasound. 20(3):253-9, 2017
                                            9. Mandelia A et al: Non-surgical management of bilateral adrenal abscess in neonates: report of two cases. J Neonatal Surg. 6(2):31, 2017
                                            10. Gyurkovits Z et al: Adrenal haemorrhage in term neonates: a retrospective study from the period 2001-2013. J Matern Fetal Neonatal Med. 1-4, 2014
                                            11. Lai LJ et al: Neonatal adrenal hemorrhage associated with scrotal hematoma: an unusual case report and literature review. Pediatr Neonatol. 53(3):210-2, 2012
                                            12. Nuchtern JG et al: A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children's Oncology Group study. Ann Surg. 256(4):573-80, 2012
                                            13. Akin MA et al: Intrahepatic and adrenal hemorrhage as a rare cause of neonatal anemia. J Perinat Med. 39(3):353-4, 2011
                                            14. Eo H et al: Comparison of clinico-radiological features between congenital cystic neuroblastoma and neonatal adrenal hemorrhagic pseudocyst. Korean J Radiol. 12(1):52-8, 2011
                                            15. Mutlu M et al: Adrenal hemorrhage in newborns: a retrospective study. World J Pediatr. 7(4):355-7, 2011
                                            16. Aucott SW et al: Early cortisol values and long-term outcomes in extremely low birth weight infants. J Perinatol. 30(7):484-8, 2010
                                            17. Kuint J et al: Early treated hypotension and outcome in very low birth weight infants. Neonatology. 95(4):311-6, 2009
                                            18. Perl S et al: Calcified adrenals associated with perinatal adrenal hemorrhage and adrenal insufficiency. J Clin Endocrinol Metab. 92(3):754, 2007
                                            19. Duman N et al: Scrotal hematoma due to neonatal adrenal hemorrhage. Pediatr Int. 46(3):360-2, 2004
                                            20. Simm PJ et al: Primary adrenal insufficiency in childhood and adolescence: advances in diagnosis and management. J Paediatr Child Health. 40(11):596-9, 2004
                                            21. Watterberg KL: Adrenocortical function and dysfunction in the fetus and neonate. Semin Neonatol. 9(1):13-21, 2004
                                            22. Arena F et al: Bilateral neonatal adrenal abscess. Report of two cases and review of the literature. Pediatr Med Chir. 25(3):185-9, 2003
                                            23. Pfluger T et al: Integrated imaging using MRI and 123I metaiodobenzylguanidine scintigraphy to improve sensitivity and specificity in the diagnosis of pediatric neuroblastoma. AJR Am J Roentgenol. 181(4):1115-24, 2003
                                            24. Subhedar NV: Treatment of hypotension in newborns. Semin Neonatol. 8(6):413-23, 2003
                                            25. Tanaka S et al: Prenatally diagnosed cystic neuroblastoma: a report of two cases. Asian J Surg. 26(4):225-7, 2003
                                            26. Bolt RJ et al: Maturity of the adrenal cortex in very preterm infants is related to gestational age. Pediatr Res. 52(3):405-10, 2002
                                            27. Manson DE et al: Pitfalls in the sonographic diagnosis of juxtadiaphragmatic pulmonary sequestrations. Pediatr Radiol. 31(4):260-4, 2001
                                            28. Westra SJ et al: Imaging of the adrenal gland in children. Radiographics. 14(6):1323-40, 1994
                                            29. Sivit CM et al: Adrenal hemorrhage in infants undergoing ECMO: prevalence and clinical significance. Pediatr Radiol. 23(7):519-21, 1993
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Adrenal hemorrhage, adrenal cortical hematoma
                                                      • Definitions

                                                        • Perinatal bleeding into normal adrenal gland
                                                        • Associated with many perinatal stressors
                                                          • Asphyxia, sepsis, birth trauma, coagulopathies

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • Ultrasonographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Birkemeier KL: Imaging of solid congenital abdominal masses: a review of the literature and practical approach to image interpretation. Pediatr Radiol. 50(13):1907-20, 2020
                                                                                      2. Schwab ME et al: Imaging modalities and management of prenatally diagnosed suprarenal masses: an updated literature review and the experience at a high volume Fetal Treatment Center. J Matern Fetal Neonatal Med. 1-8, 2020
                                                                                      3. Tognato E et al: Neonatal adrenal hemorrhage: a case series. Am J Perinatol. 37(S 02):S57-60, 2020
                                                                                      4. Alonso V et al: Conservative management of scrotal hematoma secondary to adrenal hemorrhage in newborns. Urology. 133:e1-2, 2019
                                                                                      5. Angelis D et al: Neonatal adrenal findings: significance and diagnostic approach. Description of two cases. Clin Case Rep. 6(4):658-63, 2018
                                                                                      6. Wang L et al: Clinical value of serial ultrasonography in the dynamic observation of foetal cystic adrenal lesions. Prenat Diagn. 38(11):829-34, 2018
                                                                                      7. Zessis NR et al: Severe bilateral adrenal hemorrhages in a newborn complicated by persistent adrenal insufficiency. Endocrinol Diabetes Metab Case Rep. 2018:17-0165, 2018
                                                                                      8. Bhatt S et al: Neonatal adrenal hemorrhage presenting as "acute scrotum"-looking beyond the obvious: a sonographic insight. J Ultrasound. 20(3):253-9, 2017
                                                                                      9. Mandelia A et al: Non-surgical management of bilateral adrenal abscess in neonates: report of two cases. J Neonatal Surg. 6(2):31, 2017
                                                                                      10. Gyurkovits Z et al: Adrenal haemorrhage in term neonates: a retrospective study from the period 2001-2013. J Matern Fetal Neonatal Med. 1-4, 2014
                                                                                      11. Lai LJ et al: Neonatal adrenal hemorrhage associated with scrotal hematoma: an unusual case report and literature review. Pediatr Neonatol. 53(3):210-2, 2012
                                                                                      12. Nuchtern JG et al: A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children's Oncology Group study. Ann Surg. 256(4):573-80, 2012
                                                                                      13. Akin MA et al: Intrahepatic and adrenal hemorrhage as a rare cause of neonatal anemia. J Perinat Med. 39(3):353-4, 2011
                                                                                      14. Eo H et al: Comparison of clinico-radiological features between congenital cystic neuroblastoma and neonatal adrenal hemorrhagic pseudocyst. Korean J Radiol. 12(1):52-8, 2011
                                                                                      15. Mutlu M et al: Adrenal hemorrhage in newborns: a retrospective study. World J Pediatr. 7(4):355-7, 2011
                                                                                      16. Aucott SW et al: Early cortisol values and long-term outcomes in extremely low birth weight infants. J Perinatol. 30(7):484-8, 2010
                                                                                      17. Kuint J et al: Early treated hypotension and outcome in very low birth weight infants. Neonatology. 95(4):311-6, 2009
                                                                                      18. Perl S et al: Calcified adrenals associated with perinatal adrenal hemorrhage and adrenal insufficiency. J Clin Endocrinol Metab. 92(3):754, 2007
                                                                                      19. Duman N et al: Scrotal hematoma due to neonatal adrenal hemorrhage. Pediatr Int. 46(3):360-2, 2004
                                                                                      20. Simm PJ et al: Primary adrenal insufficiency in childhood and adolescence: advances in diagnosis and management. J Paediatr Child Health. 40(11):596-9, 2004
                                                                                      21. Watterberg KL: Adrenocortical function and dysfunction in the fetus and neonate. Semin Neonatol. 9(1):13-21, 2004
                                                                                      22. Arena F et al: Bilateral neonatal adrenal abscess. Report of two cases and review of the literature. Pediatr Med Chir. 25(3):185-9, 2003
                                                                                      23. Pfluger T et al: Integrated imaging using MRI and 123I metaiodobenzylguanidine scintigraphy to improve sensitivity and specificity in the diagnosis of pediatric neuroblastoma. AJR Am J Roentgenol. 181(4):1115-24, 2003
                                                                                      24. Subhedar NV: Treatment of hypotension in newborns. Semin Neonatol. 8(6):413-23, 2003
                                                                                      25. Tanaka S et al: Prenatally diagnosed cystic neuroblastoma: a report of two cases. Asian J Surg. 26(4):225-7, 2003
                                                                                      26. Bolt RJ et al: Maturity of the adrenal cortex in very preterm infants is related to gestational age. Pediatr Res. 52(3):405-10, 2002
                                                                                      27. Manson DE et al: Pitfalls in the sonographic diagnosis of juxtadiaphragmatic pulmonary sequestrations. Pediatr Radiol. 31(4):260-4, 2001
                                                                                      28. Westra SJ et al: Imaging of the adrenal gland in children. Radiographics. 14(6):1323-40, 1994
                                                                                      29. Sivit CM et al: Adrenal hemorrhage in infants undergoing ECMO: prevalence and clinical significance. Pediatr Radiol. 23(7):519-21, 1993