Differential diagnosis of pediatric adrenal mass

Approach to the differential diagnosis of adrenal mass:

  • At birth, the way to differentiate between adrenal hemorrhage and neuroblastoma is through serial exams as adrenal hemorrhage will resolve over time
  • Beyond birth, the blood and or urine should be checked for elevated catecholemines (HVA and VMA) in neuroblastoma, elevated metabolites of norepinephrine and epinephrine (normetanephrine and metanephrine) in pheochromcytoma, and steroids in adrenocortical carcinoma
  • Symmetrical bilateral adrenal enlargement and calcification can point towards Wolman disease
  • Calcification in a unilateral adrenal mass does not help with the diagnosis