Neonatal suprarenal mass: differential diagnosis and treatment

To develop better diagnosis of and treatment strategy for suprarenal masses in the neonates. A total of 28 neonates with suprarenal mass were treated in the Department of Pediatric Surgery, Children's Hospital of Fudan University, between May 2003 and August 2010. The medical records of these patients were reviewed. The clinical, radiological, surgical and pathological data were collected. Six cases were diagnosed as having adrenal tumors, including 1 adrenal teratoma and 5 adrenal neuroblastomas (NB), and 22 cases were diagnosed as having adrenal hemorrhages. Ultrasound showed that the hematoma started to regress after 7 days to 6 months. Among the NBs, 2 cases were of stage I, 2 cases were of stage IV, and 1 case was of stage III. While 1 stage III patient and 1 stage IV patient underwent adjuvant chemotherapy after the surgery, other cases were cured by surgery alone and currently have no evidence of disease. The suprarenal mass presented cystoids or solid masses detected by ultrasound and CT both in adrenal hemorrhages and in tumors. The accurate diagnosis of neonatal suprarenal mass depends on prenatal ultrasonography, clinical manifestations, urine VMA test, CT and ultrasound, but dynamic observation of suprarenal mass by CT and ultrasound is an important means of differential diagnosis. While conservative therapy is suitable for adrenal hemorrhage, adrenal tumors need surgical excision. In addition, adrenal mass that is difficult to diagnose can be followed up for 1 month without any adverse effects on the therapy and prognosis of the tumor.