M. Gomez1,4, J. Wycech1,2, S. Rabinowitz2,3, J. Patton2,3, I. Puente1,2,3,4, A. A. Fokin2 1Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 2Delray Medical Center,Trauma Services,Delray Beach, FL, USA 3Florida Atlantic University,Charles E. Schmidt College Of Medicine,Boca Raton, FL, USA 4Florida International University,Herbert Wertheim College Of Medicine,Miami, FL, USA
Introduction:
The aim of this study was to analyze patients with Adrenal Gland Trauma (AGT) to investigate the incidence of the development of acute adrenal gland insufficiency (AGI) in polytrauma patients with blunt abdominal injuries.
Methods:
This IRB approved retrospective cohort study included 50 patients, admitted with AGT to two level 1 trauma centers (January 2012- March 2019). Analyzed variables included injury severity score (ISS), organ injury score grades (OIS), co-injuries, computed tomography (CT) imaging, surgical interventions, intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), and mortality. Adrenal Gland Insufficiency (AGI) was defined as the presence of decreased cortisol levels with simultaneously elevated Adrenocorticotropic Hormone (ACTH). The algorithm for diagnosis of AGI is presented in Figure 1. Other studied laboratory indicators of AGI included: hyperkalemia, hyponatremia, prolonged hypotension, hypoglycemia, metabolic acidosis, hypercalcemia, and decreased hematocrit.
Results:
AGT was present in 50 out of 1123 patients (4.5%) with blunt abdominal trauma. Among AGT group, mean ISS was 17.4, AG OIS was 1.2. Isolated AGT occurred in 12 (24%) patients, while the remaining 38 patients had AGT combined with other solid abdominal organ injuries. The right AG was injured in 35 patients (70.0%), the left in 14 (28.0%) and 1 patient (2.0%) had bilateral injuries. There was no angiography, embolization, or surgical intervention for the adrenal glands. Mean ICULOS and HLOS in AGT patients were 10.9 and 15.5 days, respectively. The incidences and values of the nine laboratory indicators for AGI are as follows: Cortisol deficiency (<18 mcg/dL, n=1), Elevated ACTH (>50 pg/mL AM; >10 pg/mL PM, n=0), Hyperkalemia (>5.0 mmol/L, n=3), Hyponatremia (<135 mEg/L, n=5), Hypotension (<90 mmHg SBP, n=6), Hypoglycemia (<60mg/dL, n=1), Metabolic acidosis ([HCO3]<15 mEg/L, n=9), Hypercalcemia (>2.6 mmol/L, n=1) and Decreased hematocrit (Hct:<40%, n=30). There was no incidence of elevated ACTH with simultaneously decreased serum cortisol levels. Total mortality in the AGT cohort was 6.0%.
Conclusion:
Adrenal Gland Trauma did not lead to adrenal gland insufficiency in patients with blunt abdominal organ injuries. Furthermore, no AGT patients required glucocorticosteroids support during hospital admission.
