Adrenal Injuries and Incidentalomas in Trauma Patients at an Urban Trauma Centre

Abstract

Background: Trauma patients are frequently evaluated by abdominal computed tomography. The prevalence of adrenal incidentalomas is 4% of the general population, increasing with age. The aim of this study was to examine the incidence and follow-up of adrenal lesions in an adult trauma centre.

Methods: A retrospective review was performed of all trauma admissions to an urban trauma centre in Melbourne, Australia between August 2000 and October 2009 with a discharge diagnosis including adrenal injury, mass, or adenoma.

Results: From August 2000 through October 2009, there were 45,576 patients admitted to the Alfred Hospital Trauma Unit, 142 (0.31%) patients had adrenal injuries and 26 (0.06%) patients had adrenal incidentalomas. Of the patients with adrenal injuries, the male-to-female ratio was 3:1. Blunt trauma was responsible in 99% of patients. Right-sided injuries were commoner (73%). Left-sided lesions were present in 19%, and bilateral injuries in 5% (P < 0.0001). Adrenal injury was identified as haemorrhage or haematoma in 95%. In the adrenal injury group, there was the 13% mortality. Follow-up imaging was not performed in 50% of patients; while another 30% only had imaging within 2 weeks, while still hospitalised. Of the 26 patients with incidentalomas, the male-to-female ratio was 1.6:1. All were blunt trauma patients, 69% of identified masses were left-sided lesions, 23% right-sided, and 7.7% were bilateral. Repeat imaging was obtained in 58% of patients, while the remainder was lost to follow-up. Biochemical investigations were performed in 54%. One patient had phaeochromocytoma, and 13 patients had benign incidentalomas. Three patients underwent adrenalectomy: one at the time of trauma laparotomy (benign cortical adenoma); one 5 months post-trauma (phaeochromocytoma); and the final patient 3 months post-trauma (benign vascular epithelial cyst).

Conclusions: With increased use of abdominal CT in the evaluation of trauma patients, adrenal lesions are increasingly likely to be found. Follow-up of these lesions in this series has been variable. The development of a protocol for adrenal lesions in trauma patients may improve follow-up care.




doi: http://dx.doi.org/10.4021/jcs108w