Neonatal adrenal masses: do we have reliable criteria for differential diagnosis and expectant management?

Differential diagnosis of neonatal adrenal masses (NAM) is often based on empirical criteria. Expectant management relies on spontaneous regression, described either for NB as for adrenal hemorrhage (AH). Histology was available for biopsied cases only. Aim of the study was to correlate clinical, laboratory and imaging data of a series of NAM, to final diagnosis.

Records of 23 NAM, diagnosed before or after birth, were reviewed, collecting data about: obstetrical history, clinical features, imaging, laboratory data, surgical findings, outcome.

M/F ratio was 1.6/1. Size of the lesion ranged from 17 to 50 mm.. Doppler sonography (PD) showed no flow in 14/23. Urinary catecholamines (UCM) were elevated in 5/23. Reduction in a mean time of 3 months occurred in 14/23. MIBG and CT scans resulted positive in 8 and 9 cases among 16 NAM, unvaried or increased at one month. Three cases developed as IV S NB; diagnosis was confirmed by CT guided biopsy; regression occurred within 20 months. Surgery was decided for 6 unchanged/increasing NAM after 3-6 months; they were all NB. Predictive value for NB was high for MIBG and CT scan and was lower for high UCM level and positive PD findings.

Clear criteria to differentiate AH from NB are still missing. Despite spontaneous regression is thought to indirectly confirm a non neoplastic lesion, benign evolution has also been documented for NB. As histology is available only in operated or biopsied cases, we still lack a reliable set of signs for early differentiation and to reduce repeated, invasive investigations.