EC Clinical and Medical Case Reports

The adrenal glands are paired retroperitoneal endocrine organs responsible for the secretion of catecholamines, mineralocorticoids, glucocorticoids, and androgens. Adrenal trauma is uncommon on CT (1 - 2% of blunt trauma cases) but is more frequently identified at autopsy, suggesting underdiagnosis. Post-traumatic adrenal hemorrhage is the most common adrenal injury and usually occurs unilaterally, predominantly on the right side, whereas bilateral hemorrhage is rare but potentially life-threatening because of acute adrenal insufficiency. CT is the imaging modality of choice, typically demonstrating hyperdense adrenal hematomas (50 - 80 HU), adrenal enlargement, lacerations, and surrounding fat stranding. Adrenal injuries are frequently associated with other thoracoabdominal and skeletal traumatic lesions. Diagnosis of adrenal insufficiency relies on clinical suspicion, biochemical abnormalities (hyponatremia, hyperkalemia, hypoglycemia), and hormonal assessment. Prompt corticosteroid replacement with hydrocortisone, correction of electrolyte disturbances, and supportive care are essential. Most adrenal hematomas are managed conservatively with serial CT follow-up, while embolization or adrenalectomy is reserved for ongoing hemorrhage. Bilateral hemorrhage may resolve completely or progress to adrenal atrophy requiring lifelong hormone replacement. In our patient, bilateral adrenal hematomas associated with right adrenal laceration were successfully treated with hydrocortisone and supportive management, resulting in a favorable outcome.

Keywords: Bilateral Adrenal Hematoma; Abdominal trauma; Computed Tomography (CT Scan); Acute Adrenal Insufficiency; Emergency Management

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