Overcoming combined shock: Hydrocortisone's role in adrenal insufficiency after unilateral adrenal gland injury - case report

Adrenal trauma: Role of hydrocortisone

Abstract

Introduction: Adrenal gland injury is a rare traumatic condition. Adrenal insufficiency following adrenal gland injury is even more uncommon and often overlooked, particularly in the presence of hemorrhagic shock, which is the most frequent cause of shock in trauma patients. This misdiagnosis can lead to excessive fluid resuscitation and subsequent complications.

Case presentation: A 36-year-old male sustained blunt thoracoabdominal trauma following a motor vehicle accident. Abdominal computed tomography revealed a grade II pancreatic injury, a grade II splenic injury, a grade IV kidney injury, and a left adrenal gland hematoma. During admission, the patient presented with abdominal pain and generalized guarding. An exploratory laparotomy with splenic vein repair was performed. The patient developed hypotension, and fluid resuscitation was initiated along with the administration of noradrenaline. A cortisol level was measured at 7.86 µg/dL. Therefore, hydrocortisone was infused, resulting in a gradual reduction of vasopressor support and stabilization of the patient’s hemodynamic status.

Conclusions: Severe trauma can result in combined shock. In cases of unilateral adrenal gland injury leading to low cortisol levels, prompt administration of hydrocortisone assists in improving the patient’s condition, as demonstrated in this case.