Assessment of Adrenal Function in COVID-19

Abstract

A drenal insufficiency (AI) is a treatable disorder that can be life-threatening if its diagnosis is missed. [1] Many symptoms and signs of AI may overlap with those of coronavirus disease 2019 (COVID-19) such as hypotension, diarrhea, vomiting, and hyponatremia. [1,2] Unfortunately, the status of adrenal function is unclear in COVID-19. In turn, in patients who already have AI, the prevalence of COVID-19 is unknown. In one Italian survey of 121 patients with AI (n = 40 with primary AI, and n = 81 with secondary AI), COVID-19 was reported in one patient with primary AI, that is, 0.8% prevalence. [3] The main purpose of this manuscript is to review all pertinent studies that evaluated AI among patients with COVID-19. These studies included case reports, imaging, and autopsy investigations. CASE REPORTSOnly 4 case reports were found in the literature that described new-onset AI in patients with COVID-19. [4][5][6][7] Overview of these reports is summarized in Table 1. In the first case Frankel et al. [4] from Israel reported a 66-yearold woman with a history of primary antiphospholipid syndrome (APLS) who was hospitalized for COVID-19. Her main symptoms included diffuse abdominal tenderness due to bilateral adrenal hemorrhage. [4] AI was confirmed by undetectable serum cortisol levels that failed to respond to stimulation by a synthetic adrenocorticotrophic hormone (ACTH). [4] The authors attributed this case of primary AI to adrenal hemorrhage due to thrombosis of adrenal veins caused both by APLS and COVID-19. [4] In the second report from France, Maria et al. [5] described another patient with primary APLS who also presented with abdominal pain in addition to diffuse thrombosis in the lower extremity. However, the MINI-REVIEW