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

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Suprarenal gland
        • Definitions

          • Part of hypothalamic-pituitary axis that regulates many body functions & responds to stress
          • Adrenal cortex: Largest part of adrenal gland; 3 layers produce different hormones (described below from superficial to deep)
            • Zona glomerulosa: Aldosterone (mineralocorticoid)
              • Retains sodium & wastes potassium; regulates fluid & electrolyte balance, helps maintain BP
            • Zona fasciculata: Cortisol (glucocorticoid)
              • Regulates metabolism of glucose, protein, & fat; responds to stress by ↑ blood glucose levels & cardiac output
            • Zona reticularis: Dehydroepiandrosterone
              • Sex hormone that works much like testosterone
          • Adrenal medulla: Makes & stores epinephrine, norepinephrine

        IMAGING

        • General Features

          • Imaging Recommendations

            DIFFERENTIAL DIAGNOSIS

              PATHOLOGY

              • Gross Pathologic & Surgical Features

                CLINICAL ISSUES

                • Presentation

                  Selected References

                  1. Aderotimi TS et al: Ultrasound of the adrenal gland in children. Ultrasound. 29(1):48-56, 2021
                  2. Hanafy AK et al: Imaging features of adrenal gland masses in the pediatric population. Abdom Radiol (NY). 45(4):964-81, 2020
                  3. Lesieur E et al: Prenatal assessment of atypical adrenal glands: a systematic approach for diagnosis. J Ultrasound Med. 40(8):1719-28, 2020
                  4. Alonso V et al: Conservative management of scrotal hematoma secondary to adrenal hemorrhage in newborns. Urology. 133:e1-2, 2019
                  5. Iijima S: Sonographic evaluation of adrenal size in neonates (23 to 41 weeks of gestation). BMC Pediatr. 18(1):60, 2018
                  6. Majmudar A et al: "Lying-down" adrenal sign: there are exceptions to the rule among fetuses and neonates. J Ultrasound Med. 36(12):2599-603, 2017
                  7. Paltiel H et al: The pediatric kidney and adrenal glands. In Rumack CM et al: Diagnostic Ultrasound. 5th ed. Elsevier Mosby. 1775-832, 2017
                  8. Ben-Mordechay D et al: Sonographic detection of accessory adrenal tissue in neonates. J Ultrasound Med. 35(5):959-63, 2016
                  9. Bittman ME et al: Focal adrenal lesions in pediatric patients. AJR Am J Roentgenol. 200(6):W542-56, 2013
                  10. Wassner AJ et al: Endocrine physiology in the newborn. Semin Pediatr Surg. 22(4):205-10, 2013
                  11. Yao W et al: Neonatal suprarenal mass: differential diagnosis and treatment. J Cancer Res Clin Oncol. 139(2):281-6, 2013
                  12. Akin MA et al: Intrahepatic and adrenal hemorrhage as a rare cause of neonatal anemia. J Perinat Med. 39(3):353-4, 2011
                  13. Kutluk G et al: Bilateral adrenal abscesses as a complication of neonatal suprarenal hemorrhage. Pediatr Int. 52(4):e207-8, 2010
                  14. Nykänen P et al: Serum concentrations of adrenal steroids and their precursors as a measure of maturity of adrenocortical function in very premature newborns. Horm Res Paediatr. 74(5):358-64, 2010
                  15. Buyukkayhan D et al: Effect of antenatal betamethasone use on adrenal gland size and endogenous cortisol and 17-hydroxyprogesterone in preterm neonates. J Pediatr Endocrinol Metab. 22(11):1027-31, 2009
                  16. Duman N et al: Scrotal hematoma due to neonatal adrenal hemorrhage. Pediatr Int. 46(3):360-2, 2004
                  17. Merrot T et al: Prenatally detected cystic adrenal mass associated with Beckwith-Wiedemann syndrome. Fetal Diagn Ther. 19(6):465-9, 2004
                  18. Ng PC et al: Transient adrenocortical insufficiency of prematurity and systemic hypotension in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 89(2):F119-26, 2004
                  19. Rahmah R et al: Bilateral adrenal cysts and ectopic pancreatic tissue in Beckwith-Wiedemann syndrome: is a conservative approach acceptable? J Pediatr Endocrinol Metab. 17(6):909-12, 2004
                  20. Watterberg KL: Adrenocortical function and dysfunction in the fetus and neonate. Semin Neonatol. 9(1):13-21, 2004
                  21. Subhedar NV: Treatment of hypotension in newborns. Semin Neonatol. 8(6):413-23, 2003
                  22. Sul HJ et al: Congenital neuroblastoma with multiple metastases: a case report. J Korean Med Sci. 18(4):618-20, 2003
                  23. Walther FJ et al: Adrenal suppression and extubation rate after moderately early low-dose dexamethasone therapy in very preterm infants. Early Hum Dev. 74(1):37-45, 2003
                  24. Hibbert J et al: The ultrasound appearances of neonatal renal vein thrombosis. Br J Radiol. 70(839):1191-4, 1997
                  25. Westra SJ et al: Imaging of the adrenal gland in children. Radiographics. 14(6):1323-40, 1994
                  26. Avni EF et al: Sonographic demonstration of congenital adrenal hyperplasia in the neonate: the cerebriform pattern. Pediatr Radiol. 23(2):88-90, 1993
                  27. Sivit CM et al: Adrenal hemorrhage in infants undergoing ECMO: prevalence and clinical significance. Pediatr Radiol. 23(7):519-21, 1993
                  28. Sivit CJ et al: Sonography in neonatal congenital adrenal hyperplasia. AJR Am J Roentgenol. 156(1):141-3, 1991
                  Related Anatomy
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                  Related Differential Diagnoses
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                  References
                  Tables

                  Tables

                  KEY FACTS

                  • Imaging

                    • Top Differential Diagnoses

                      • Clinical Issues

                        TERMINOLOGY

                        • Synonyms

                          • Suprarenal gland
                        • Definitions

                          • Part of hypothalamic-pituitary axis that regulates many body functions & responds to stress
                          • Adrenal cortex: Largest part of adrenal gland; 3 layers produce different hormones (described below from superficial to deep)
                            • Zona glomerulosa: Aldosterone (mineralocorticoid)
                              • Retains sodium & wastes potassium; regulates fluid & electrolyte balance, helps maintain BP
                            • Zona fasciculata: Cortisol (glucocorticoid)
                              • Regulates metabolism of glucose, protein, & fat; responds to stress by ↑ blood glucose levels & cardiac output
                            • Zona reticularis: Dehydroepiandrosterone
                              • Sex hormone that works much like testosterone
                          • Adrenal medulla: Makes & stores epinephrine, norepinephrine

                        IMAGING

                        • General Features

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  Selected References

                                  1. Aderotimi TS et al: Ultrasound of the adrenal gland in children. Ultrasound. 29(1):48-56, 2021
                                  2. Hanafy AK et al: Imaging features of adrenal gland masses in the pediatric population. Abdom Radiol (NY). 45(4):964-81, 2020
                                  3. Lesieur E et al: Prenatal assessment of atypical adrenal glands: a systematic approach for diagnosis. J Ultrasound Med. 40(8):1719-28, 2020
                                  4. Alonso V et al: Conservative management of scrotal hematoma secondary to adrenal hemorrhage in newborns. Urology. 133:e1-2, 2019
                                  5. Iijima S: Sonographic evaluation of adrenal size in neonates (23 to 41 weeks of gestation). BMC Pediatr. 18(1):60, 2018
                                  6. Majmudar A et al: "Lying-down" adrenal sign: there are exceptions to the rule among fetuses and neonates. J Ultrasound Med. 36(12):2599-603, 2017
                                  7. Paltiel H et al: The pediatric kidney and adrenal glands. In Rumack CM et al: Diagnostic Ultrasound. 5th ed. Elsevier Mosby. 1775-832, 2017
                                  8. Ben-Mordechay D et al: Sonographic detection of accessory adrenal tissue in neonates. J Ultrasound Med. 35(5):959-63, 2016
                                  9. Bittman ME et al: Focal adrenal lesions in pediatric patients. AJR Am J Roentgenol. 200(6):W542-56, 2013
                                  10. Wassner AJ et al: Endocrine physiology in the newborn. Semin Pediatr Surg. 22(4):205-10, 2013
                                  11. Yao W et al: Neonatal suprarenal mass: differential diagnosis and treatment. J Cancer Res Clin Oncol. 139(2):281-6, 2013
                                  12. Akin MA et al: Intrahepatic and adrenal hemorrhage as a rare cause of neonatal anemia. J Perinat Med. 39(3):353-4, 2011
                                  13. Kutluk G et al: Bilateral adrenal abscesses as a complication of neonatal suprarenal hemorrhage. Pediatr Int. 52(4):e207-8, 2010
                                  14. Nykänen P et al: Serum concentrations of adrenal steroids and their precursors as a measure of maturity of adrenocortical function in very premature newborns. Horm Res Paediatr. 74(5):358-64, 2010
                                  15. Buyukkayhan D et al: Effect of antenatal betamethasone use on adrenal gland size and endogenous cortisol and 17-hydroxyprogesterone in preterm neonates. J Pediatr Endocrinol Metab. 22(11):1027-31, 2009
                                  16. Duman N et al: Scrotal hematoma due to neonatal adrenal hemorrhage. Pediatr Int. 46(3):360-2, 2004
                                  17. Merrot T et al: Prenatally detected cystic adrenal mass associated with Beckwith-Wiedemann syndrome. Fetal Diagn Ther. 19(6):465-9, 2004
                                  18. Ng PC et al: Transient adrenocortical insufficiency of prematurity and systemic hypotension in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 89(2):F119-26, 2004
                                  19. Rahmah R et al: Bilateral adrenal cysts and ectopic pancreatic tissue in Beckwith-Wiedemann syndrome: is a conservative approach acceptable? J Pediatr Endocrinol Metab. 17(6):909-12, 2004
                                  20. Watterberg KL: Adrenocortical function and dysfunction in the fetus and neonate. Semin Neonatol. 9(1):13-21, 2004
                                  21. Subhedar NV: Treatment of hypotension in newborns. Semin Neonatol. 8(6):413-23, 2003
                                  22. Sul HJ et al: Congenital neuroblastoma with multiple metastases: a case report. J Korean Med Sci. 18(4):618-20, 2003
                                  23. Walther FJ et al: Adrenal suppression and extubation rate after moderately early low-dose dexamethasone therapy in very preterm infants. Early Hum Dev. 74(1):37-45, 2003
                                  24. Hibbert J et al: The ultrasound appearances of neonatal renal vein thrombosis. Br J Radiol. 70(839):1191-4, 1997
                                  25. Westra SJ et al: Imaging of the adrenal gland in children. Radiographics. 14(6):1323-40, 1994
                                  26. Avni EF et al: Sonographic demonstration of congenital adrenal hyperplasia in the neonate: the cerebriform pattern. Pediatr Radiol. 23(2):88-90, 1993
                                  27. Sivit CM et al: Adrenal hemorrhage in infants undergoing ECMO: prevalence and clinical significance. Pediatr Radiol. 23(7):519-21, 1993
                                  28. Sivit CJ et al: Sonography in neonatal congenital adrenal hyperplasia. AJR Am J Roentgenol. 156(1):141-3, 1991