title: Traumatic adrenal injuries.
abstract: OBJECTIVE
  We determined the prevalence, management and general prognosis of blunt isolated and nonisolated adrenal injuries in a pediatric population.
  
  
  METHODS
  We analyzed trauma data from a pediatric institution for the period 1991 to 1998 to identify patients with blunt traumatic adrenal injuries diagnosed by computerized tomography. We then performed a detailed chart review to obtain data on the presence of concomitant intra-abdominal and extra-abdominal injuries, transfusion requirements, intensive care unit monitoring requirements, hospital course and the presence of followup studies.
  
  
  RESULTS
  Among 9,199 pediatric trauma cases we identified 20 adrenal injuries (0.22%), of which 15 (75%) were nonisolated and 5 (25%) were isolated. The right adrenal gland was injured in 17 (85%) of the 20 patients. In the 15 nonisolated adrenal injuries concomitant injury to the liver (13 cases, 87%) and ipsilateral kidney (8 cases, 53%) were most common. Three (60%) of the 5 patients with isolated adrenal injury required transfusion for adrenal hemorrhage. No patient required intensive care unit monitoring or operative intervention. Only 2 (10%) of the 20 patients underwent followup computerized tomography, both of whom had resolution of the adrenal injury.
  
  
  CONCLUSIONS
  In the pediatric population blunt adrenal injuries are rare and typically present as part of a multiorgan trauma. The right adrenal gland is more likely to be injured, with liver trauma as the most commonly associated injury, followed by ipsilateral renal injury. Although there is a possibility of significant adrenal hemorrhage requiring transfusion, adrenal trauma is typically self-limited and does not require intensive care monitoring or operative intervention.
authors.affiliation: Division of Urology, University of California San Diego Medical Center, San Diego, California 92103-8897, USA.
authors.forename: Lamia
authors.initials: L
authors.lastname: Gabal-Shehab
authors.forename: Madhu
authors.initials: M
authors.lastname: Alagiri
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology; D000311:Adrenal Glands / Q000293:injuries*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D002648:Child; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007668:Kidney / Q000293:injuries; D008099:Liver / Q000293:injuries; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*