Abstract
We report the case of a 57-year-old man who sustained an isolated severe traumatic brain injury (TBI). During his admission to the intensive care unit (ICU), he developed marked arterial hypotension of unclear cause. Eventually, the presence of renal angle tenderness on clinical examination and a low random-cortisol level lead to the suspicion of primary adrenal insufficiency. A computed tomography scan of his abdomen demonstrated new bilateral adrenal haemorrhages. This diagnosis is not unlikely to be missed, as symptoms and laboratory tests are often nonspecific.
Highlights
Bilateral adrenal haemorrhages in the context of traumatic brain injury (TBI) are difficult to diagnose clinically despite appropriate symptoms and laboratory parameters as these are often nonspecific
Serum cortisol levels or the short synacthen test may not be specific for the diagnosis of primary adrenal insufficiency in critical ill patients, and there is a lack of data regarding normal cortisol levels in critical illness [1,2,3,4] Diagnosis can be made with computed tomography scan of the abdomen
We report a case of bilateral adrenal haemorrhages in an isolated TBI
Summary
Bilateral adrenal haemorrhages in the context of traumatic brain injury (TBI) are difficult to diagnose clinically despite appropriate symptoms and laboratory parameters as these are often nonspecific. An intra-parenchymal Codman catheter was inserted to monitor intra-cranial pressure Following his admission to our intensive care unit, the patient developed intracranial hypertension, which was controlled with deep sedation, continuous paralysis, targeted temperature management and infusion of hypertonic saline. He required in the first 4 days of his intensive care unit (ICU) admission infusion of noradrenaline in a dose of up to 0.25 mcg/kg/min and concomitant infusion of vasopressin at a dose of up to 0.01 U/min to maintain an adequate cerebral perfusion pressure. The patient was subsequently transferred to a rehabilitation centre where initially he had been progressing well with mobility and cognition He represented eventually with postural hypotension, which lead to an increase of fludrocortisone to 0.15 mg
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