ESPE Abstracts

Background: We describe the case of a male newborn, presenting in our outpatient endocrinological clinic after suffering from a bilateral adrenal haemorrhage in the context of a moderate perinatal asphyxia.

Case Presentation: The term male newborn was born spontaneously from breech position after a prolonged labour in a secondary care centre in Freiburg, Germany. Perinatal BGA showed severe metabolic acidosis (pH 6.99, BE -23.5mmol/l, lactate 17.5mmol/l) and the newborn presented signs of hypoxic encephalopathy (Bayley score 6, aEEG with burst suppression pattern). After transfer to the NICU, 72 hours of therapeutic hypothermia treatment was performed. The patient presented electrolyte abnormalities (hyponatremia 126mmol/l, hyperkalemia 6.6mmol/l) and severe arterial hypotension, an abdominal sonography showed bilateral adrenal haemorrhage (Figure 1). The lab showed low-normal cortisol and elevated ACTH, confirming primary adrenal insufficiency (Table 1). Hydrocortisone therapy (15 mg/m²/d) was started on day 4, fludrocortisone (0.1 mg/d) was added on day 8, and oral sodium replacement (4mmol/kg/d) was added after oral feeds were tolerated. Regular brain ultrasounds showed no evidence of intracerebral haemorrhage. The patient was discharged home at the age of two weeks and presented in our endocrinology outpatient clinic for follow-up. On day 16, the adrenal haemorrhages were decreasing in size (Figure 2), the lab still showed high ACTH and low-normal cortisol levels. At 77 days, sonography showed normal adrenal glands with complete haemorrhage resorption (Figure 3). The patient underwent an ACTH test at the age of 98 days, which showed an insufficient increase of cortisol levels, confirming persisting adrenal insufficiency (Table 2). We plan further 3-monthly follow-up visits to monitor adrenal function.

Conclusion: This case underlines the importance of considering adrenal haemorrhage as a possible complication of perinatal asphyxia. ACTH and cortisol levels should be determined, and abdominal sonography should be performed in severely ill newborns. Early diagnosis and prompt treatment of adrenal insufficiency are of crucial importance. This case also raises the question whether adrenal function can recover over time after resorption of the haematoma. Only few cases of newborns with bilateral adrenal haemorrhage with adrenal insufficiency are described in literature, so few data are available about a possible recovery of adrenal function.