An Uncommon Cause of Neonatal Hypertension

Document Type : Case Report


Faculty of Medicine, Erciyes University, Kayseri, Turkey


Background: Adrenal hematoma is a very rare acquired cause of neonatal hypertension. In this study, we report a case of neonatal hypertension associated with adrenal hematoma. A male neonate was immediately transferred to our neonatal intensive care unit after delivery due to meconium aspiration. He needed to be on mechanical ventilation support. During his hospital stay, hospital records showed normal blood pressure. However, 15 days after discharge, he was diagnosed with hypertension and was admitted to our Nephrology Division. Except for irritability, physical examination was normal. Blood pressure was normal, while right renal agenesis, grade two dilatation in the collective system of the left kidney, a round heterogeneous cyst (measuring 46×28 mm), and adrenal hematoma with no blood flow in the left suprarenal region were detected by ultrasound. Renal scintigraphy showed right renal agenesis, prolonged retention of the injected material in the left kidney, and a mass on the left kidney. Antihypertensive therapy was initiated for the neonate and the adrenal hematoma was checked weekly. The mass gradually shrank and his blood pressure readings returned to normal for his age.
Conclusion: Neonates with hypertension and history of birth complications should be evaluated for adrenal hematoma to determine the reasons for hypertension.


  1. Garcia-Pratz JA, Mattoo TK, Kim MS.Etiology, clinical features, and diagnosis of neonatal hypertension.UpToDate. Available at: URL.; 2015.
  2. Blowey DL, Duda PJ, Stokes P, Hall M. Incidence and treatment of hypertension in the neonatal intensive care unit. J Am Soc Hypertens. 2011; 5(6):478-83.
  3. Sahu R, Pannu H, Yu R, Shete S, Bricker JT, Gupta-Malhotra M. Systemic hypertension requiring treatment in the neonatal intensive care unit. J Pediatr. 2013; 163(1):84-8.
  4. Yao W, Li K, Xiao X, Zheng S, Chen L. Neonatal Suprarenal mass: differential diagnosis and treatment. J Cancer Res Clin Oncol. 2013; 139(2):281-6.
  5. Guignard JP, Gouyon JB, Adelman RD. Arterial hypertension in the newborn infant. Biol Neonate. 1989; 55(2):77-83.
  6. Dionne JM, Abitbol CL, Flynn JT. Hypertension in infancy: diagnosis, management and outcome. Pediatr Nephrol. 2012; 27(1):17–32.
  7. Batisky DL. Neonatal hypertension. Clin Perinatol. 2014; 41(3):529-42.
  8. Sirota L, Strauss S, Rechnitz Y, Landman I, Dulitzky F. Transient obstruction of the kidney and hypertension due to neonatal adrenal hemorrhage. Case report. Helv Paediatr Acta. 1985; 40(2-3):177-81.
  9. Gali S, Anat I. Purely cystic adrenal lesion in a newborn evolving into a solid neuroblastoma. J Clin Ultrasound. 2015; 43(2):126-8.

10. Habeb AM, Zulali MA, Yamani AS, Yassine SM. Neonatal adrenal hematoma with urinary tract infection: risk factor or a chance association. Saudi J Kidney Dis Transpl. 2014; 25(2):376-80.

11. Velaphi SC, Perlman JM. Neonatal adrenal hemorrhage: clinical and abdominal sonographic findings. Clin Pediatr (Phila). 2001; 40(10):545-8.

12. Akuzawa N, Nakamura T, Tanaka A, Ikeda S, Fukuda T, Sakamaki T, et al. Transient hypertension due to adrenal hemorrhage in a patient with von Recklinghausen's disease. Intern Med. 1997; 36(4):289-92.

13. Schmidt J, Mohr VD, Metzger P, Zirngibl H. Posttraumatic hypertension secondary to adrenal hemorrhage mimicking pheochromocytoma: case report. J Trauma. 1999; 46(5):973-5.