Endocrine Abstracts

Introduction: Foetal adrenal haemorrhage is relatively rare with a reported incidence of 0.2% in neonates. We share our experience of two neonates who were diagnosed to have adrenal haemorrhage in our centre over last 5 years. We also carried out a retrospective review of literature on existing evidence regarding diagnosis and evaluation of neonates with adrenal haemorrhage.

Methodology: Two neonates with confirmed adrenal haemorrhage were identified from radiology and foetal medicine data-base. Their case notes were reviewed. An extensive literature review was carried out on PubMed, Cochrane database using keywords ‘foetus’/‘neonate’ AND ‘Adrenal haemorrhage’.

Case 1: A growth scan was carried out antenatally in view of 2-vessel cord which incidentally detected a left adrenal haemorrhage. The neonate was delivered by uncomplicated vaginal delivery. The newborn examination was normal. A post-natal abdominal ultrasound showed bulky left adrenal gland although it was smaller than previous scan. A repeat ultrasound at 3-months, showed gradual resolution of adrenal haemorrhage.

Case 2: An adrenal haemorrhage was noted incidentally on an antenatal scan. There was no history of sepsis, prolonged labour or traumatic birth. The neonate was born by normal vaginal delivery and newborn examination was unremarkable. Serial ultrasound abdomen showed gradual resolution of adrenal haemorrhage.

Review of literature and discussion: Adrenal haemorrhage is relatively common in neonates with reported incidence of 0.2% in neonates although in our experience only 2 neonates were radiologically diagnosed to have adrenal haemorrhage over last 5-years. It is likely that many adrenal haemorrhages remain unrecognised and therefore under-reported. Prematurity, prolonged labour, sepsis and hypoxia are predisposing factors for adrenal haemorrhage although both of our patients were diagnosed incidentally. Foetal adrenal haemorrhage also needs to be considered in neonates presenting with persistent jaundice. Neuroblastoma remains an important differential diagnosis especially in neonates with suspected unilateral adrenal haemorrhage. Clinical presentation and presence of predisposing factors and serial Doppler ultrasound changes help distinguish unilateral adrenal haemorrhage from neuroblastoma which is usually associated with poor prognosis and aggressive clinical course. Most of the adrenal haemorrhages are self-resolving and do not require long term adrenal hormone replacement.