Adrenal gland trauma is a rare condition that typically stems from blunt force trauma, and is associated with multiple organ injuries. Alternatively, isolated adrenal gland trauma is extremely rare, accounting for only 1.5 to 4% of all adrenal trauma cases. While isolated adrenal trauma is a mostly self-limiting condition, it is potentially life-threatening, representing a significant cause of bleeding, and/or hypotension due to adrenal insufficiency and adrenal crisis. Due to its rare occurrence, there are no reported guidelines for monitoring and observing isolated adrenal trauma.
Here we report on an isolated adrenal hemorrhage from a blunt trauma without associated injuries. A 53-year-old white man presented with abdominal pain after a high-speed motor vehicle accident. An initial evaluation revealed minimal abdominal pain and negative focused assessment with sonography for trauma examination; computed tomography imaging revealed a significant fluid collection consistent with adrenal hemorrhage. He was observed in our intensive care unit for 24 hours, and had stable hemoglobin and vital signs, after which he was discharged. At 1-month follow-up, he reported persistent intermittent abdominal pain, which was completely resolved by the 4-month follow-up.
This case report demonstrates isolated adrenal gland injury resulting from significant blunt trauma to the abdomen. There are no current guidelines for monitoring isolated adrenal hemorrhage. Recognizing possible adrenal injury in blunt trauma cases is important due to potentially severe adrenal hemorrhage; therefore, we recommend follow-up with serial abdominal computed tomography until the resolution of hemorrhage and symptoms.
Udobi KF, Childs EW. Adrenal crisis after traumatic bilateral adrenal hemorrhage. J Trauma. 2001;51(3):597–600. PubMed
Liao CH, Lin KJ, Fu CY, Wang SY, Yang SJ, Ouyang CH. Adrenal gland trauma: is extravasation an absolute indication for intervention? World J Surg. 2015;9(5):1312–9. CrossRef
Stawicki SP, Seamon MJ, Carvalho CM, et al. Adrenal gland injury secondary to blunt traumatic mechanisms: a marker of overall injury severity. Endokrynol Pol. 2009;60(1):2–8. PubMed
Sano F, et al. Pheochromocytoma manifested by traumatic adrenal hemorrhage. Hinyokika Kiyo. 2006;52(1):15–7. PubMed
May EE, Beal AL, Beilman GJ. Traumatic hemorrhage of occult pheochromocytoma: a case report and review of the literature. Am Surg. 2000;66(8):720–4. PubMed
- Isolated unilateral adrenal gland hemorrhage following motor vehicle collision: a case report and review of the literature
- BioMed Central