Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Management of Neonatal Adrenal Masses: A Single Center Experience: A Retrospective Study
Neonatal Sürrenal Kitlelerin Yönetimi: Tek Merkez Deneyimi: Retrospektif Çalışma
Olga Devrim AYVAZa, Sabri CANSARANa, Cengiz GÜLa, Ayşenur CELAYİRa
aDepartment of the Pediatric Surgery, University of Health Sciences Zeynep Kamil Women and Children Diseases Training and Research Hospital, İstanbul, Türkiye
Turkiye Klinikleri J Med Sci. 2022;42(2):95-100
doi: 10.5336/medsci.2022-87999
Article Language: EN
Full Text
ABSTRACT
 Objective: Adrenal hemorrhage in newborns is a rare condition with a frequency of 0.2-0.55%. Various risk factors have been reported besides asphyxia resulting from sepsis, coagulation disorders and traumatic delivery. In this study, we aimed to evaluate the results of our neonatal cases who were followed-up and treated due to adrenal hemorrhage/mass. Material and Methods: Patients followed-up(neuroblastoma follow-up protocol)/operated due to adrenal mass between 2007-2021 were retrospectively analyzed. Gender, diagnosis age-type, laterality data, laboratory-ultrasound(US) findings were recorded and examined. Results: Along 14 years, two patients with bilateral renal hypoplasia of 44 patients who were evaluated with the preliminary diagnosis of adrenal mass were excluded, so 42 patients were included. Eighteen (42.9%) patients were male, 24 (57.1%) were female, 7 were antenatally-diagnosed, mean age of diagnosis was 11 days in those diagnosed-postnatally. 23 had right, 13 had left, and 6 had bilateral surrenal masses. 38 were cystic, 7 were semisolid, 3 were solid. On the first US, the mean mass size was 34x23mm-the mean mass volume was 12mL. The mean mass size was 31x19mm-the mean mass volume was 8mL in the third month. Urine vanilla mandelic acid levels were normal in all patients. In follow-up, three patients were operated because they had solid lesion size over 16mL. One of them underwent pyeloplasty due to ureteropelvic junction obstruction, two had bening pathology. Conclusion: Differential diagnosis between neonatal neuroblastoma and adrenal hemorrhage can be difficult. Follow-up with US-Doppler US and tumor markers is useful and the most reliable method in distinguishing neuroblastoma and adrenal hemorrhage.

Keywords: Neonatal; hemorrhage; neuroblastoma
ÖZET
 Amaç: Yenidoğanda adrenal kanama %0,2-0,55 sıklıkta nadir görülen bir durumdur. Sepsis, pıhtılaşma bozuklukları ve travmatik doğum nedeniyle oluşan asfiksinin yanı sıra çeşitli risk faktörleri bildirilmiştir. Bu çalışmada, adrenal hemoraji/kitle nedeniyle takip ve tedavi edilen neonatal olgularımızın sonuçlarının değerlendirilmesi amaçlandı. Gereç ve Yöntemler: 2007-2021 yılları arasında sürrenal kitle nedeniyle nöroblastom takip protokolüne göre takip ve tedavi edilen olgular retrospektif olarak incelendi. Hastaların cinsiyet, tanı yaşı ve şekli, lezyon tarafı verileri ve laboratuvar-ultrason bulguları kayıtlanarak analiz edildi. Bulgular: On dört yılda sürrenal kitle ön tanısı ile değerlendirilen 44 hastadan 2'sinde bilateral renal hipoplazi tespit edilmiş olması nedeniyle 42 hasta çalışmaya dâhil edildi. Olguların 18'i (%42,9) erkek, 24'ü (%57,1) kız olmak üzere 7'si antenatal tanılıydı ve postnatal tanı konulanların ortalama tanı yaşı 11 gündü. 23'ünde sağ, 13'ünde sol, 6'sında ise bilateral sürrenal kitle tespit edildi. Kırk iki hastada toplam 48 sürrenal kitlenin 38'i kistik, 7'si semisolid, 3'ü ise solid yapıdaydı. İlk ultrasonda ortalama kitle boyutu 34x23 mm-ortalama kitle hacmi 12 mL olarak hesaplandı. Üçüncü ay ultrasonlarında ortalama kitle boyutu 31x19 mm-ortalama kitle hacmi 8 mL bulundu. İdrar vanilmandelik asit düzeyi tümünde normaldi. Takiplerinde solid lezyon boyutu 16 mL üzerinde seyreden 3 olgu opere edildi; 1'inde üreteropelvik bileşke obstrüksiyonu nedeniyle pyeloplasti yapılırken, diğer 2'sinde patoloji benign şeklinde raporlandı. Sonuç: Yenidoğanda sürrenal lezyonlarda nöroblastom ve adrenal kanama ayırıcı tanısı güçtür. Tümör belirteçleri ile birlikte ultrason ve Doppler ultrason ile lezyon boyutlarının ve kanlanmasının takip edilmesi, nöroblastom ve adrenal kanamayı ayırt etmede en güvenilir yöntemdir.

Anahtar Kelimeler: Neonatal; hemoraji; nöroblastom
REFERENCES:
  1. Toti MS, Ghirri P, Bartoli A, Caputo C, Laudani E, Masoni F, et al. Adrenal hemorrhage in newborn: how, when and why- from case report to literature review. Ital J Pediatr. 2019;45(1):58. [Crossref]  [PubMed]  [PMC] 
  2. Nixon AM, Botou A, Aggeli C, Falidas E, Choreftaki T, Zografos GN. Haemorrhage in pre-existing adrenal masses. A case series. Int J Surg Case Rep. 2020;69:76-8. [Crossref]  [PubMed]  [PMC] 
  3. Du L, Liu L, Zhang C, Cai W, Wu Y, Wang J, et al. Role of surgery in the treatment of patients with high-risk neuroblastoma who have a poor response to induction chemotherapy. J Pediatr Surg. 2014;49(4):528-33. [Crossref]  [PubMed] 
  4. Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364-89. [Crossref]  [PubMed]  [PMC] 
  5. May CJH, Asia M, Karavitaki N, Arlt W, Guest P, OReilly MW. Bilateral adrenal haemorrhage. QJM Int J Med. 2017;110:169-71. [Crossref] 
  6. Gyurkovits Z, Maróti Á, Rénes L, Németh G, Pál A, Orvos H. Adrenal haemorrhage in term neonates: a retrospective study from the period 2001-2013. J Matern Fetal Neonatal Med. 2015;28(17):2062-5. [Crossref]  [PubMed] 
  7. Al-Jurayyan RNA, Al-Hakami AA, Al-Jurayyan NAM. Adrenal haemorrhage in the new born: revisited. Biomedical Research 2018;29(20):3674-7. [Crossref] 
  8. Demirel N, Baş AY, Zenciroğlu A, Taşci-Yildiz Y. Adrenal bleeding in neonates: report of 37 cases. Turk J Pediatr. 2011;53(1):43-7. [PubMed] 
  9. Ural ÜM, Tekin YB, Balık G, Şentürk Ş, Şahin FK. Fetal adrenal hematom. Türkiye Klinikleri J Gynecol Obst. 2015;25(1):50-2. [Crossref] 
  10. Çicek C, Emral Lİ, Sarıcı D, Altun D, Sarıcı SÜ. Sürrenal hemoraji: seyrek görülen bir tedaviye dirençli hiperbilirübinemi nedeni [Surrenal hemorrhage:a rare cause of treatment-resistant hyperbilirubinemia]. Çocuk Sağlığı ve Hastalıkları Dergisi. 2018;61:70-2. [Link] 
  11. Katar T, Taşkesen M, Akay Öztürkmen H. Yenidoğanlarda hiperbilirübineminin önemli bir nedeni: adrenal hematom [An important cause of hyperbilirubinemia in a newborn: adrenal hematoma]. J Pediatr Research. 2015;2(2):84-6. [Crossref] 
  12. Yamagiwa I, Obata K, Saito H. Prenatally detected cystic neuroblastoma. Pediatr Surg Int. 1998;13(2-3):215-7. [Crossref]  [PubMed] 
  13. Postek G, Streich H, Narębski K. Assessment of diagnostic methods in adrenal gland hemorrhage in neonates on the basis of own material from the years 2007-2011. Pol J Radiol. 2011;76(3):62-4. [PubMed]  [PMC] 
  14. Goksugur SB, Bekdas M, Yorgun M, Altunhan H, Karatas Z, Dilek M, Demircioglu F. A rare cause of hypertension in a newborn: adrenal hemorrhage. Nat J Physiol Pharm Pharmacol. 2015;5:157-9. [Crossref] 
  15. Nuchtern JG, London WB, Barnewolt CE, Naranjo A, McGrady PW, Geiger JD, et al. A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children's Oncology Group study. Ann Surg. 2012;256(4):573-80. [Crossref]  [PubMed]  [PMC] 
  16. Emre Ş, Özcan R, Bakır AC, Kuruğoğlu S, Çomunoğlu N, Şen HS, et al. Adrenal masses in children: imaging, surgical treatment and outcome. Asian J Surg. 2020;43(1):207-12. [Crossref]  [PubMed] 
  17. Mutafoğlu K, Olgun N. Untreated Follow-up Protocol for Perinatal Surrenal Masses. TPOG Infant Surrenal Mass Monitoring Protocol (TPOG-İSKİP). İzmir; 2011. [Link] 
  18. Turkish Pediatric Oncology Group (TPOG) Neuroblastoma 2020 Protocol. [Link] 
  19. Balkan B, Türk M, Moralar DG, Yaşaroğlu S, Yektaş S, Hergünsel GO. Çocuk hastalarda manyetik rezonans görüntüleme esnasındaki sedasyon/anestezi deneyimlerimiz [Sedation/anestehesia experiences during magnetic resonance imaging procedure in the pediatric patients]. J Pediatr Emerg Intensive Care Med. 2018;5:69-74. [Crossref] 

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