Bilateral Adrenal Hemorrhage in a 6-Day-Old Neonate Presenting with Hematuria of 2 Days Duration: Case Report

BACKGROUND: 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. CASE DETAIL: 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). CONCLUSION: 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.