title: Pediatric adrenal trauma in the 21st century: Children's Hospital of Atlanta experience.
abstract: OBJECTIVE
  Adrenal trauma in children is rare and poorly characterized. To characterize these injuries better, we reviewed the contemporary experience at a large pediatric trauma center.
  
  
  METHODS
  We queried the trauma registry of Children's Hospitals of Atlanta for all patients treated for adrenal trauma (ICD-9 codes 868.01 and 868.11) between January 1, 2000 and December 31, 2009. We performed a detailed chart review.
  
  
  RESULTS
  Of 12,045 patients who were treated for trauma during the study period 42 children (0.35%) with adrenal injuries were identified. All injuries resulted from blunt trauma. Motor vehicle crash was the most common mechanism, responsible for 41% of injuries. A total of 41 cases (98%) were diagnosed by computerized tomography and 1 during exploratory laparotomy for associated vascular injury. Injuries were to the right adrenal gland in 36 cases (86%), left in 5 (12%) and bilateral in 1 (2%). The most common associated regions were the liver (55%), head or brain (33%) and skeleton (31%). Five patients (12%) experienced isolated adrenal injuries. One patient required treatment for adrenal insufficiency and none required adrenalectomy, adrenalorrhaphy or adrenal embolization. Of patients with isolated adrenal injuries 2 were hospitalized and 3 were treated as outpatients. All had an unremarkable course.
  
  
  CONCLUSIONS
  Adrenal trauma in children is rare. Although typically associated with high morbidity, this outcome is likely from related injuries as an isolated adrenal injury generally portends a benign course.
authors.affiliation: Department of Urology, Emory University School of Medicine, Children's Hospitals of Atlanta, Atlanta, Georgia, USA. figler@gmail.com
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Figler
authors.forename: Rachel
authors.initials: R
authors.lastname: Webman
authors.forename: Christina
authors.initials: C
authors.lastname: Ramey
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kaye
authors.forename: Ellen
authors.initials: E
authors.lastname: Patrick
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirsch
authors.forename: Edwin
authors.initials: E
authors.lastname: Smith
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
mesh_terms: D000293:Adolescent; D000311:Adrenal Glands / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005845:Georgia; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy