A Rupture in Silence: A Life-threatening Neonatal Adrenal Bleed.

Neonatal adrenal hemorrhage (NAH) is a rare condition that commonly presents with retroperitoneal bleeding in neonates. We report a term male neonate born through vaginal delivery who presented with respiratory distress and shock on the first day of his life. Examination revealed pallor, abdominal distension and a tender lumbar mass. Laboratory tests showed severe anemia, and imaging studies confirmed a large perirenal hematoma with absent adrenal shadow. The diagnosis was right adrenal rupture causing hemorrhagic shock. Prompt resuscitation and conservative management led to a favorable outcome. NAH should be considered in neonates presenting with shock and abdominal mass, mimicking renal disorders.