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Adrenal Hemorrhage
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Surveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly — Erika Newman, Neuroblastoma · 9:58
Neuroblastoma
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Dr. Daniel von Allmen, surgeon-in-chief at Cincinnati Children’s, joins Dr. Rae Hanke to review the essentials of neuroblastoma in this videocast.
video · May 2020
Neuroblastoma
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Drs Erika Newman, Dan von Allmen and Tony Sandler join Dr. Todd Ponsky in a discussion covering the latest in neuroblastoma. Contributing editor: Rachel (Rae) Hanke, MD
Case 1: Mother who presents with 26 week fetus
with a pr
podcast56:19 · Dec 2020
Neuroblastoma
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Drs Erika Newman, Dan von Allmen and Tony Sandler join Dr. Todd Ponsky in a discussion covering the latest in neuroblastoma. Time Stops 00:00:31 Introductions
podcast56:16 · Jun 2026
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Neuroblastoma
Adrenal hemorrhage is the most common differential diagnosis for prenatal suprarenal mass, more common with history of fetal stress
clinicalDaniel von Allmen2:11 ↗
Other differential diagnoses for suprarenal mass include neuroblastoma, pulmonary sequestration below the diaphragm, and misdiagnosed renal anomaly
clinicalDaniel von Allmen2:11 ↗
Familial neuroblastoma occurs in about 1% of patients
epidemiologicalTony Sandler4:39 ↗
For prenatal suprarenal mass, first postnatal study should be ultrasound of the abdomen
guidelineTodd Ponsky5:07 ↗
CT scan or MRI not needed for 3 cm lesion unless urine catecholamines are elevated
guidelineTony Sandler5:34 ↗
MIBG scan is the next step if catecholamines are elevated
guidelineDaniel von Allmen6:02 ↗
Radiologists are quite good at identifying adrenal hemorrhage on ultrasound
opinionDaniel von Allmen6:02 ↗
In perinatal phase, most common metastatic sites are liver, bone, skin, and lymph nodes
clinicalDaniel von Allmen8:14 ↗
Nocktern study data supports observation of prenatal neuroblastoma with careful ultrasound surveillance
guidelineDaniel von Allmen8:44 ↗
Of 84 observed patients in Nocktern study, 16 (approximately 20%) underwent resection for growth or family preference
epidemiologicalTony Sandler10:39 ↗
Nocktern study showed approximately 98% event-free survival and 100% overall survival in observed prenatal neuroblastoma
epidemiologicalErika Newman11:07 ↗
First-year surveillance protocol: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spaced out to one year
guidelineErika Newman11:37 ↗
After one year, surveillance becomes every six months, then yearly
guidelineErika Newman11:37 ↗
Case report: child with observed prenatal adrenal mass that resolved presented at age 3 with widely metastatic high-risk neuroblastoma
clinicalDaniel von Allmen12:27 ↗
5 centimeters is used as size cutoff for surgical intervention in observed prenatal masses
guidelineTony Sandler14:36 ↗
Volume increase of more than 50% is criterion for considering surgery
guidelineTodd Ponsky15:08 ↗
50% increase in VMA or HVA prompts consideration of surgery
guidelineTodd Ponsky15:08 ↗
Laparoscopic approach is reasonable for masses less than 6 centimeters
guidelineErika Newman16:07 ↗
Lymph node status in neuroblastoma is not as important for therapy changes as in Wilms tumor
clinicalDaniel von Allmen16:36 ↗
Biology of neuroblastoma is more important than lymph node status for treatment decisions
clinicalErika Newman17:00 ↗
Stage MS (formerly 4S) with skin lesions and liver mets still tends to have good biology
clinicalErika Newman17:30 ↗
Primary concern in stage MS with liver involvement is mass effect causing respiratory compromise
clinicalDaniel von Allmen17:58 ↗
Stage MS without distress can be treated with aggressive observation
guidelineErika Newman17:58 ↗
Once respiratory compromise begins, treatment options include chemotherapy, radiation, or emergent decompressive laparotomy
guidelineErika Newman17:58 ↗
Classic findings of stage MS (high catecholamines, blue blebs on skin, liver metastasis, adrenal mass) may not require biopsy
opinionDaniel von Allmen19:06 ↗
Liver biopsy in newborns is difficult because bleeding is hard to control
clinicalErika Newman19:52 ↗
If NMYC is amplified in stage MS, staging changes from MS to M
clinicalTodd Ponsky20:40 ↗
VIP secretion can cause severe diarrhea in neuroblastoma
clinicalErika Newman21:05 ↗
Initial workup for abdominal mass includes ultrasound to determine solid vs cystic, then CT with PO and IV contrast if solid
guidelineErika Newman21:05 ↗
Ultrasound is important for Wilms tumor to assess venous extension
clinicalTony Sandler22:56 ↗
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