Bilateral adrenal hemorrhage and nesidioblastosis in a newborn

Nesidioblastosis and acute insufficiency of the adrenal gland are rare caus es of severe neonatal hypoglycemia. We report on a macrosome newborn with b ilateral adrenal hemorrhage and severe hypoglycemia inspite of substitution with hydrocortisone. Conservative treatment with Diazoxid and Hydrochlorot hiazid and high doses of Glucose caused no significant improvement. Subsequ ently subtotal pancreatectomy was performed. Histochemopathology showed dif fuse hyperplasia of the beta-cells. Conclusion: Bilateral adrenal hemorhage of a macrosome newborn with severe hypoglycemia is suspect not only of insufficiency of the adrenal gland but also of hyperinsulinism which has to be excluded.