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Adrenal Trauma: Elvis Presley Memorial Trauma Center Experience

  • Reza Mehrazin
    Affiliations
    Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Ithaar H. Derweesh
    Correspondence
    Reprint requests: Ithaar H. Derweesh, M.D., Department of Urology, University of Tennessee Health Science Center, Urology Service, Regional Medical Center at Memphis, 956 Court Avenue, Room H-210, Memphis, TN 38163.
    Affiliations
    Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee

    Urology Service, Regional Medical Center at Memphis, Memphis, Tennessee
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  • Matthew C. Kincade
    Affiliations
    Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Adam C. Thomas
    Affiliations
    Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee

    Urology Service, Regional Medical Center at Memphis, Memphis, Tennessee
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  • Robert Gold
    Affiliations
    Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee

    Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Robert W. Wake
    Affiliations
    Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee

    Urology Service, Regional Medical Center at Memphis, Memphis, Tennessee
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      Objectives

      Adrenal gland injury is a potentially devastating event if unrecognized in the treatment course of a trauma patient. We reviewed our single-center experience and outcomes in patients with adrenal gland trauma.

      Methods

      We performed a retrospective review of all patients presenting with trauma to the Regional Medical Center at Memphis who had adrenal gland injuries from January 1991 through March 2006. Each chart was reviewed with attention to the demographics, associated injuries, complications, and outcomes. Patients were stratified into two subgroups according to age (35 years or younger and older than 35 years) to allow for an age-based comparison between the two groups.

      Results

      Of 58,000 patients presenting with trauma, 130 (0.22%) were identified with adrenal injuries, of which 8 (6.2%) were isolated and 122 (93.8%) were not. Of these 130 patients, 125 (96.2%) had their injury diagnosed by computed tomography and 5 (3.8%) had their injury diagnosed during exploratory laparotomy. Right-sided injuries predominated (78.5%), with six (4.6%) bilateral. Four patients (3.1%) underwent adrenalectomy. Seven patients (5.4%) with adrenal injuries died. One patient (0.77%) required chronic steroid therapy. Patients older than 35 years were more likely to have complications such as deep venous thrombosis, pneumonia, and urinary tract infections. Patient age of 35 years or younger was associated with a significantly increased incidence of liver lacerations.

      Conclusions

      Adrenal gland injury is uncommon, although mostly associated with greater injury severity. Although adding to morbidity, most are self-limited and do not require intervention.
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      References

        • Canton E.
        Apoplexy of the suprarenal capsule.
        Trans Pathol Soc Lond. 1863; 14: 257
        • Stawicki S.P.
        • Hoey B.A.
        • Grossman M.D.
        • et al.
        Adrenal gland trauma is associated with high injury severity and mortality.
        Curr Surg. 2003; 40: 431-436
        • Gómez R.G.
        • McAninch J.W.
        • Carroll P.R.
        Adrenal gland trauma: diagnosis and management.
        J Trauma. 1993; 35: 870-874
        • Guichelaar M.
        • Leenen L.
        • Braams R.
        Transient adrenocortical insufficiency following traumatic bilateral adrenal hemorrhage.
        J Trauma. 2004; 56: 1135-1137
        • Luchtman M.
        • Breitgand A.
        Traumatic adrenal hemorrhage in children: an indicator of visceral injury.
        Pediatr Surg Int. 2000; 16: 586-588
        • Lewis J.V.
        Bilateral adrenal hemorrhage after blunt trauma: diagnosis by computed tomography.
        South Med J. 1994; 87: 1269-1271
        • Porter J.M.
        • Muscato K.
        • Patrick J.R.
        Adrenal hemorrhage: a comparison of traumatic and nontraumatic deaths.
        J Natl Med Assoc. 1995; 87: 569-571
        • Francque S.M.
        • Schwagten V.M.
        • Ysebaert D.K.
        • et al.
        Bilateral adrenal hemorrhage and acute adrenal insufficiency in a blunt abdominal trauma: a case-report and literature review.
        Eur J Emerg Med. 2004; 11: 164-167
        • Gabal-Shehab L.
        • Alagiri M.
        Traumatic adrenal injuries.
        J Urol. 2005; 173: 1330-1331
        • Sinelnikov A.O.
        • Abujudeh H.H.
        • Chan D.
        • et al.
        CT manifestations of adrenal trauma: experience with 73 cases.
        Emerg Radiol. 2007; 13: 313-318
        • Claussen M.S.
        • Landercasper J.
        • Cogbill T.H.
        Acute adrenal insufficiency presenting as shock after trauma and surgery: three cases and review of the literature.
        J Trauma. 1992; 32: 94-100
        • Rana A.I.
        • Kenney P.J.
        • Lockhart M.E.
        • et al.
        Adrenal gland hematomas in trauma patients.
        Radiology. 2004; 230: 669-675
        • Murphy B.J.
        • Casillas J.
        • Yrizarry J.M.
        Traumatic adrenal hemorrhage: radiologic findings.
        Radiology. 1988; 169: 701-703
        • McGehee M.
        • Kier R.
        • Cohn S.M.
        • et al.
        Comparison of MRI with postcontrast CT for the evaluation of acute abdominal trauma.
        J Comput Assist Tomogr. 1993; 17: 410-413
        • Santucci R.A.
        • Fisher M.B.
        The literature increasingly supports expectant (conservative) management of renal trauma—a systematic review.
        J Trauma. 2005; 59: 493-503
        • Baccot S.
        • Tiffet O.
        • Bonnot P.
        • et al.
        Bilateral posttraumatic adrenal hemorrhage: case report of a patient with acute adrenal insufficiency.
        Ann Chir. 2000; 125: 273-275
        • Udobi K.F.
        • Childs E.W.
        Adrenal crisis after traumatic bilateral adrenal hemorrhage.
        J Trauma. 2001; 51: 597-600