title: Traumatic adrenal gland injury: epidemiology and outcomes in a major Australian trauma center.
abstract: BACKGROUND
  Adrenal gland injury (ADGI) is quite rare and mostly associated with other organ injuries secondary to blunt thoracoabdominal trauma. Bilateral ADGI has severe consequences if not discovered in the treatment course of trauma victims.
  
  
  OBJECTIVE
  To review our experience of management of ADGI, epidemiology, and outcomes in a major Australian trauma institute.
  
  
  METHODS
  A retrospective analysis of all patients presenting with thoracoabdominal trauma to the Alfred Hospital who had been diagnosed with adrenal gland injury between July 2001 and July 2007.
  
  
  RESULTS
  Of 3,921 patients with blunt thoracoabdominal injuries, 2.4% were identified with blunt ADGI (70 males and 26 women, age range 15-85 years). Right adrenal injuries occurred in 72.9%, left adrenal injuries in 22.9%, and bilateral ADGI in 4.2%. Computed tomography (CT) scan findings revealed 82.2% of acute injuries to be hyperdense hematoma expanding and distorting the adrenal gland. Periadrenal stranding and hemorrhagic changes around the adrenal limbs were seen in 12.5%. Oval or round lesions were seen in 3.1%. Surgery was performed in 25% of the study group for associated thoracoabdominal injuries. Patients with left adrenal gland injury had higher rates of mortality and morbidity, and length of stay.
  
  
  CONCLUSIONS
  ADGI is being increasingly recognized with the widespread use of CT scan in the evaluation of multitrauma patients. ADGI is usually self-limiting and typically managed nonoperatively. Acute adrenal insufficiency should be considered and investigated in case of unexplained hypotension in uni- or bilateral ADGI.
authors.affiliation: Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia. abuosamah123@hotmail.com.|National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia. abuosamah123@hotmail.com.
authors.forename: M M
authors.initials: MM
authors.lastname: Alsayali
authors.affiliation: Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Atkin
authors.affiliation: Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Rahim
authors.affiliation: National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
authors.forename: L E
authors.initials: LE
authors.lastname: Niggemeyer
authors.affiliation: Department of Radiology, The Alfred Hospital, Melbourne, Australia.
authors.forename: O
authors.initials: O
authors.lastname: Doody
authors.affiliation: Department of Radiology, The Alfred Hospital, Melbourne, Australia.|Department of Surgery, Monash University, Melbourne, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Varma
keywords: Adrenal injuries; CT scan; Clinical presentation; Retroperitoneal hematoma
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