Extensive Bilateral Calcification Within Adrenal Hemorrhage

Adrenal hemorrhage, or suprarenal apoplexy, to use a more violent and impelling term, is a not infrequent occurrence in infancy and childhood. The hemorrhage may involve one or both glands, may be microscopically insignificant, with no destruction of parenchyma, or may be so extensive as to turn the whole adrenal into a blood sac (1). Snelling and Erb (2) reviewed 3,637 consecutive autopsies performed at the Hospital for Sick Children in Toronto and found evidence of adrenal hemorrhage in 43 cases—an incidence of slightly more than 1 per cent, but Potter (3) considers this figure too high. Calcification is either normal or pathological, depending upon whether deposition of calcium salts occurs in tissues set aside for the formation and development of bone or elsewhere. Pathological calcification usually occurs in tissues or organs which have suffered localized destructive changes—fatty degeneration, hyalinization, or necrosis—through either circulatory damage, toxic invasion, inflammatory involvement, alteration of the acid-base equilibrium, or disturbances in the function of glands of internal secretion (4, 5). The basic concept is that dead or injured tissue, so extensive or so situated that it is not readily absorbed by circulating fluids, can become infiltrated with calcium salts. Widmann (6) described pathological calcification as metastatic or dystrophic. In “metastatic calcification” lime salts are deposited in tissues where some generalized rarefying bone disease causes increase of plasma calcium. In “dystrophic calcification“ dead tissue which does not suppurate becomes infiltrated with lime salts. Although calcification frequently occurs in localized areas of hemorrhage, it is rarely found within hemorrhage of the adrenal gland (2, 5, 7). Out of Snelling and Erb's 43 autopsied cases of adrenal hemorrhage in infants and children, only 8 showed any calcification within the adrenal, and in not one of the number was this diagnosed antemortem. Adrenal gland calcification appears as a diffuse calcareous deposit or as a triangular, lunate, ovoid, or rounded opacification above the mesial half of the upper pole of the kidney. To be differentiated are tuberculosis associated with Addison's disease, and neoplasms (ganglioneuroma, neuroblastoma, pheochromocytoma, and carcinoma). We were encouraged to report the following case because of the unusual degree of calcification in the adrenal glands of an infant who lived almost two years after the initial extensive hemorrhage. Report of Case A. M., a white female infant, was prematurely delivered on June 12, 1949, at Binghamton City Hospital. Presentation was a frank breech, and forceps were used on the after-coming head. The pregnancy had been uneventful. Two days after birth, pneumonia developed but recovery ensued and the child was discharged in good condition. She was re-admitted on Oct. 19, 1949, because of vomiting. The lungs and abdomen were negative on physical examination.