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
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