Adrenal hemorrhage in a newborn.
Sometimes in the course of care in a neonatal intensive care unit, there may be a rush to intervene in cases where limited intervention is actually the correct course. One such example is that of neonatal adrenal hemorrhage. We present the case of a male term neonate with shock, metabolic acidosis, distended abdomen, and falling hematocrit. His prenatal and delivery histories were uneventful except for a nuchal cord. Apgar scores were 9 and 9. Because of his dramatic presentation, certain members of the medical team suggested immediate surgical intervention. However, a calm and careful evaluation revealed the true diagnosis and course of action. Ultrasound of the abdomen showed a mass between the liver and kidney, but the origin was difficult to identify. A computed tomography scan supported the diagnosis of right adrenal hemorrhage. His serum cortisol level was normal. The patient was managed conservatively and discharged home after a 1-week stay in the hospital. Subsequent abdominal ultrasound showed resolving adrenal hemorrhage with minimal calcification. A review of the pertinent literature is presented. Physicians should remember adrenal hemorrhage when evaluating a newborn infant with shock, acidosis, abdominal distention, and falling hematocrit and that conservative management is usually indicated.
Abdu
Arebu T
AT
Division of Neonatology, Department of Pediatrics, University of Kentucky College of Medicine, Kentucky Children's Hospital, Lexington, KY 40536, USA. abadtu2@uky.edu
Kriss
Vesna M
VM
Bada
Henrietta S
HS
Reynolds
Eric W
EW
D000307:Adrenal Gland Diseases / Q000175:diagnosis* / Q000628:therapy; D003937:Diagnosis, Differential; D006470:Hemorrhage / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D008297:Male