Adrenal Trauma: Elvis Presley Memorial Trauma Center Experience

doi:10.1016/j.urology.2007.07.004

Urology

Volume 70, Issue 5, November 2007, Pages 851-855

https://doi.org/10.1016/j.urology.2007.07.004 Get rights and content

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.

Section snippets

Material and Methods

We performed a retrospective analysis of trauma patients who presented to the Elvis Presley Memorial Trauma Center of the Regional Medical Center at Memphis who had traumatic adrenal gland injuries from January 1991 through March 2006. Patients were pooled from two different trauma databases and International Classification of Diseases, Ninth Revision, discharge diagnoses. We excluded patients whose diagnosis was not confirmed radiologically or by exploratory laparotomy.

The records were

Results

The demographic data are presented in Table 1. More than 58,000 patients presented with trauma from January 1991 through March 2006. Of these patients, 130 (0.22%) were identified with adrenal injuries. Of the injuries, 129 (99.2%) occurred as a consequence of blunt trauma and 1 (0.8%) was secondary to a gunshot wound; 125 (96.2 %) were diagnosed by CT and 5 (3.8%) during exploratory laparotomy. The average patient age was 37.9 ± 16.6 years (median, 34.5, range 15 to 82), 63% were male and 37%

Comment

Adrenal gland hemorrhage is a rare entity that is mostly encountered in trauma patients. Other than case series, not many reports of large patient series dealing with adrenal gland trauma have been published. To our knowledge, this is the only large single-institutional series reported to date. In a statewide study from Pennsylvania, a 0.15% incidence of adrenal hemorrhage was reported in 210,508 trauma patients.² In other studies, the incidence of adrenal gland trauma has ranged from 0.03% to

Conclusions

The results of our study have found that adrenal gland injuries are rare and are most often associated with high injury severity. Most are self-limited and do not require operative intervention, with less than 1% of patients requiring long-term steroid supplementation. The mortality rate is approximately 6%.

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There are more references available in the full text version of this article.

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Adult urologyAdrenal Trauma: Elvis Presley Memorial Trauma Center Experience

Objectives

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Conclusions

Curr Surg

J Urol

Ann Chir

Apoplexy of the suprarenal capsule

Trans Pathol Soc Lond

Adrenal gland trauma: diagnosis and management

J Trauma

Transient adrenocortical insufficiency following traumatic bilateral adrenal hemorrhage

J Trauma

Traumatic adrenal hemorrhage in children: an indicator of visceral injury

Pediatr Surg Int

Bilateral adrenal hemorrhage after blunt trauma: diagnosis by computed tomography

South Med J

Adult urology
Adrenal Trauma: Elvis Presley Memorial Trauma Center Experience