Trauma: Adrenal Gland Trauma

General

• Rare Injury (0.44% of Traumas)
• More Common on the Right (75-85%)
• Associated with High Injury Severity Scores (ISS)
• Isolated Injury is Very Rare
• Most Common Concomitant Injuries: Liver #1 & Kidney #2
• May Be Related to Future Development of Adrenal Myelolipomas

Adrenal Insufficiency

• Adrenal Trauma Itself Is Not an Independent Risk Factor for Adrenal Insufficiency
• Adrenal Insufficiency is Associated with High ISS & Increasing Age

Mechanism of Injury

• Blunt Trauma: Crushing, Shearing or Bursting Forces
  • Bursting Force – Acute Rise in Venous Pressure from IVC Compression by Abdominal Impact
    • Reason for Increased Right-Sided Incidence (Shorter Vein)
• Penetrating Trauma

AAST Adrenal Organ Injury Scale

• *See AAST
• Injury Scale is Under Copyright

Treatment

• Mostly Conservative Management
• Extravasation: Surgery vs Transarterial Embolization (TAE)
  • May Consider Conservative Management if Only Extravasation but Normotensive
  • Surgical Options: Adrenalectomy vs Repair