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Adrenocortical Insufficiency Secondary to Traumatic Bilateral Adrenal Hemorrhage in a Child.
Jill K Johnstone, Daniel S Kim, John Cassese, Mimi Kim, Francois I Luks
Brown Medical School, Providence, RI
Objective: The incidence of traumatic adrenal hemorrhage in the pediatric population is unknown. Traumatic bilateral adrenal hemorrhage is extremely rare in adults and children. The occurrence of adrenal insufficiency secondary to bilateral adrenal hemorrhage is potentially fatal.
Design: Case report.
Setting: Tertiary care children's hospital and trauma center.
Patients: Case report - 11-year-old girl.
Interventions: The patient was struck by a school bus and suffered multiple injuries, including pulmonary contusions, pelvic fractures, a femur fracture, bilateral adrenal hemorrhage and left renal artery thrombosis.
Main Outcome Measures: N/A
Results: Early in her hospital course she was suspected to have adrenal insufficiency based on intermittent hypotension despite fluid resuscitation and lack of other bleeding sources. The diagnosis was confirmed by low serum cortisol and elevated adrenocorticotropic hormone levels.
Conclusions: A review of the literature suggests that this is the first reported case of adrenal insufficiency secondary to traumatic bilateral adrenal hemorrhage in a child. Adrenal insufficiency is particularly difficult to diagnose after trauma, as the usual presenting signs and symptoms, including fever, hypotension and abdominal pain, may also be a result of the injuries themselves.
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