Fact-sheet: Adrenal hemorrhage
Updated on 10/05/2016 at 2:34 PM
View all RADEOS cases associated with this fact-sheet
Definition
Poorly known frequency (neonatal period > childhood).
Mechanism: gland hypertrophy during the neonatal period, hemorrhagic involution.
Multiple causes in newborns:
-vitamin K deficiency (historical, systematic vitamin K supplementation now given to newborns)
-perinatal distress and hypoxia
-maternal diabetes
-obstetric trauma
-infection
-any hemorrhagic syndrome
-ECMO (extracorporeal membrane oxygenation), renal vein thrombosis.
In adults:
- Spontaneous etiologies:
Stress (intensive care, septic shock...),
Primary / iatrogenic coagulopathies,
Underlying tumor,
Idiopathic
- Post-traumatic
Clinical features
No functional consequence.
In adults, adrenal insufficiency if hematoma involves both adrenal glands.
Ultrasound
Ultrasound:
-neonatal period: heterogeneous, predominantly hyperechoic mass, well-defined, of variable size, avascular
-evolution: progressive centrifugal liquefaction with thick walls, septation, ring-like calcifications.
Decrease in size over 3 to 6 weeks.
No benefit to performing CT or MRI.
CT
- Spontaneously hyperdense collection
- Retroperitoneal: Spleen displaced anteriorly, Kidneys displaced inferiorly
- "Absent organ" sign: non-visualization of the affected Adrenal gland.
Management
Simple ultrasound follow-up.
Difficult differential diagnosis:
Neuroblastoma: stable echostructure, slowly increasing size, may be hemorrhagic in the initial phase --> urinary catecholamine assay if any doubt.
In adults: -
Surgical treatment -
Watchful waiting
