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Correspondence to Author: Asabel Nenezes, 

Unidade de Adrenal, Laboratório de Hormônios e Genética Molecular LIM/42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

ABSTRACT: 
Context : Although COVID-19 is a prothrombotic and proinflammatory illness, its effects on adrenal function have not been sufficiently studied.
Report on a case : Following a COVID-19 infection, a 46-yearold lady showed signs of hyperpigmentation, hypotension, and abdominal pain. Serum cortisol was less than 1.0 µg/dL, aldosterone was less than 3 ng/dL, and adrenocorticotropin (ACTH) was 807 pg/mL in the patient with hyponatremia. Bilateral adrenal infarction was supported by computed tomography (CT) observations of adrenal enlargement with no parenchymal and little peripheral capsular enhancement following contrast. The patient had no prior thrombotic episodes, although she did have positive antiphospholipid antibodies and autoimmune hepatitis. Intravenous hydrocortisone was used as the first treatment for the patient, and then oral hydrocortisone and fludrocortisone.
Discussion : : In COVID-19, we found nine articles—including case reports—that described adrenal insufficiency that developed recently and/or adrenal hemorrhage or infarction on CT. Five cases had hormonal diagnoses of adrenal insufficiency, although only three had measured ACTH levels (high in one, normal/low in the other two). Five studies showed evidence of bilateral adrenal hemorrhagic or nonhemorrhagic infarction (two with adrenal insufficiency, two with normal cortisol levels, and one with no data). It’s interesting to note that antiphospholipid syndrome was previously diagnosed in the lone instance with well-characterized new-onset acute primary adrenal insufficiency following COVID-19. In our instance, the diagnosis of antiphospholipid syndrome was made subsequent to the COVID-19-induced adrenal infarction. In conclusion, our results corroborate the hypothesis that COVID-19-induced antiphospholipid syndrome and bilateral adrenal infarction are related. Consequently, during COVID-19, individuals with positive antiphospholipid antibody tests need to be cautiously watched for any indications of severe adrenal insufficiency.

Citation:

Asabel Nenezes. Insufficiency of Primary Adrenals Owing to COVID-19 Bilateral Adrenal Infarction. Journal of Clinical Endocrinology and Metabolism 2024.