Journal of Emergencies, Trauma, and Shock
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CASE REPORT
Year : 2019  |  Volume : 12  |  Issue : 1  |  Page : 61-63

Empiric stress dose steroids in trauma patients: A case report of hypopituitarism in traumatic hemorrhage


1 Touro University California, Vallejo, CA, USA
2 Department of Surgery, Natividad Medical Center, Salinas, CA, USA

Correspondence Address:
Dr. Andrew McCague
Natividad Medical Center, 1441 Constitution Blvd, Salinas, CA 93906
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_85_18

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Trauma patients experience relative adrenal insufficiency or critical illness-related corticosteroid insufficiency (CIRCI) in majority of 60% of patients. It has been shown that both septic shock and trauma cause dysfunction of the hypothalamic–pituitary axis and, in some cases, structural damage to the adrenal glands themselves through hemorrhage or infarction. Empiric steroids are used commonly in patients with septic shock for patients who are refractory to fluids and vasopressors. Here, we present a unique case of a 40-year-old male with multisystem trauma who developed adrenal crisis treated by empiric stress-dose steroids. His history later revealed a history of hypopituitarism. Although data do not support the use of empiric steroids for trauma patients, this case illustrates an example where considering steroid use and keeping adrenal insufficiency and CIRCI in the differential can influence outcome.


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