Tilahun Tsion, Diriba Gezahegn, Berhane Melkamu
Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia.
Int Med Case Rep J. 2021 Mar 25;14:183-185. doi: 10.2147/IMCRJ.S294475. eCollection 2021.
The adrenal gland of newborns is susceptible to hemorrhage because of its relative larger size and high vascularity. Adrenal hemorrhage is bilateral in 10% of the cases. Neonates with adrenal hemorrhage present with anemia, jaundice, abdominal mass, and, rarely, adrenal insufficiency.
A 6-day-old macrosomic neonate presented with hematuria of 2 days duration. Delivery was difficult. Abdominal ultrasound demonstrated bilateral suprarenal echo complex mass (right 4.3 cm by 2.2 cm and left 4 cm by 2 cm) and abdominal CT scan showed bilateral hypo-dense non-enhancing fluid-attenuated suprarenal gland masses (right 4.3 cm by 2.5 cm and left- 3.9 cm by 2.4 cm).
Adrenal hemorrhage should be considered and looked for in at-risk newborns like those with macrosomia, overwhelming sepsis, and perinatal asphyxia as well as those with bleeding diathesis. Although rare, hematuria is one of the clinical features of adrenal hemorrhage in neonates. Asymptomatic neonates with adrenal hemorrhage may not need any intervention except close follow up.
新生儿肾上腺因其相对较大的体积和丰富的血管而容易发生出血。10%的病例中肾上腺出血为双侧性。患有肾上腺出血的新生儿表现为贫血、黄疸、腹部肿块，很少出现肾上腺功能不全。
一名6日龄巨大儿新生儿出现持续2天的血尿。分娩困难。腹部超声显示双侧肾上腺回声复合性肿块（右侧4.3厘米×2.2厘米，左侧4厘米×2厘米），腹部CT扫描显示双侧低密度、无强化、液体衰减的肾上腺肿块（右侧4.3厘米×2.5厘米，左侧3.9厘米×2.4厘米）。
对于有风险的新生儿，如巨大儿、严重脓毒症、围产期窒息以及有出血倾向者，应考虑并检查是否存在肾上腺出血。血尿虽罕见，但却是新生儿肾上腺出血的临床特征之一。无症状的肾上腺出血新生儿除密切随访外可能无需任何干预。
