Bilateral adrenal haemorrhage and acute adrenal insufficiency in a blunt abdominal trauma: a case-report and literature review

Abstract

Blunt abdominal trauma is frequently associated with adrenal haemorrhage, and is preferentially diagnosed by computed tomography scan. Lesions are mostly unilateral and asymptomatic and are therefore frequently overlooked. Bilateral haemorrhage, however, has a high mortality rate as a result of acute adrenal insufficiency. We report on a 30-year-old polytraumatic patient who developed cardiocirculatory arrest when all lesions were surgically controlled and stable and without evidence of a primary cardiac problem. Autopsy revealed bilateral adrenal haemorrhage, leading to the diagnosis of acute adrenal insufficiency as the cause of death. We conclude that adrenal haemorrhage should be looked for in every polytrauma patient, and that although it is a rare occurrence, acute adrenal insufficiency caused by bilateral adrenal haemorrhage should be considered in every patient with unexplained cardiocirculatory failure. Such patients may benefit from the prompt administration of corticosteroid replacement, which can be life saving.