Direct trauma to the adrenal glands resulting in adrenal gland failure is relatively rare. We present two cases of post-traumatic hypoadrenalism.
Case 1: A 53-year-old male who was trapped under a lorry trailer. He was found to have fractures of T6 (unstable), T12, rib and sternal fractures. He was transferred to the orthopaedic ward and required a spinal splint. He was slowly recovering until day 20 of his admission when he became hypotensive and tachycardic. Blood tests demonstrated hyponatraemia and hyperkalaemia. Despite fluid resuscitation and emergency treatment for hyperkalaemia he remained hypotensive with major electrolyte abnormalities.
Endocrine opinion was requested and he was found to have an abnormal short Synacthen test. His hypotension and electrolyte abnormality rapidly responded to glucocorticoid and mineralocorticoid treatment. A repeat short Synacthen test has confirmed hypoadrenalism.
Case 2: A 57-year-old man was injured when a lorry cab fell on him. He had fractures of the T2T4 thoracic vertebrae which were unstable, rib fractures and a pneumothorax. He had a long admission to ITU and then HDU and made slow clinical progress. Eventually several weeks after admission, due to ongoing problems with hypotension and hyperkalaemia the endocrine team were asked to review him. A short Synacthen test was performed which was grossly abnormal.
After starting steroid replacement good clinical progress was made and he was subsequently discharged home having made a full recovery but with hypoadrenalism.
Both patients had been well prior to their traffic accidents and had no family history of autoimmune disease. The other hormone axes were tested and found to be normal and neither patient had adrenal autoantibodies.
We think both patients had sustained critical damage to their adrenal gland circulation due to the major trauma and developed hypoadrenalism several weeks into their illness.