An Important Cause of Hyperbilirubinemia in a Newborn: Adrenal Hematoma

Aim: In the present study, our aim was to investigate demographical, clinical characteristics and outcomes of management in seven patients with hyperbilirubinemia and adrenal hemorrhage detected in abdominal ultrasonography admitted with the complaint of icterus. Materials and Methods: In this retrospective study, we reviewed the medical records of seven patients with adrenal al hematoma diagnosed with abdominal ultrasonography. Physical examination findings, blood group types, direct Coombs test, total blood count, biochemical parameter, T4, TSH, G-6PD, CRP, total urine examination, PT, aPTT, treatment and duration of follow-up and abdominal ultrasonography findings were evaluated. Results: The presenting complaint was icterus. Two patients were females and five were males. All of the patients were born via vaginal delivery. One patient was born at home, six were born in hospital. On admission, physical examination findings revealed icterus in all cases, and there was abdominal mass in four of them. In the etiology of hyperbilirubinemia, blood group incompatibility (ABO, Rh or subgroup), hemolysis was not detected. All cases were diagnosed with adrenal hemorrhage. Adrenal hemorrhage was rightsided in 6 newborns, bilateral in 1. Adrenal insufficiency was not observed. Exchange transfusion was performed to 3 patients, and phototherapy was administered to 5. Resolution of adrenal hemorrhage was observed in ultrasonographic follow-up. Conclusion: In cases of hyperbilirubinemia of unknown etiology, adrenal hemorrhage must be kept in mind. Adrenal hematoma should also be considered in the differential diagnosis of hyperbilirubinemia. We recommend abdominal ultrasonography for further evaluation.