Complex endocrine pathology discovered during investigations performed after politrauma - forensic implications

Abstract

Assault victims can develop multiple complications from physical and psychological damage to aggravation of previous medical conditions, with many forensic consequences. A 51-year male, known with type 1 diabetes mellitus and autoimmune hypothyroidism, was the victim of a traumatic assault on the street. The patient had multiple bruises but no fractures. The bruises healed normally but anterior cervical and abdominal pain persisted for more than 2 weeks so he was referred for further investigation. The ultrasound examination suggested a small hemorrhage in previously unknown thyroid nodules and also in a newly discovered adrenal mass. Thyroidectomy was recommended and the pathological examination diagnosed squamous metaplasia. After a complete hormonal evaluation, the patient also underwent unilateral adrenalectomy and a benign corticoadenoma was found. A traumatic event may contribute to the diagnosis of otherwise asymptomatic or even unusual pathology such as Hashimoto thyroiditis (HT)-associated macronodular thyroid disease involving a squamous metaplasia associated with an adrenal non-functioning tumor. If physical or psychological stress may play a pathogenic role for these co-morbidities is still a matter of debate.