Bilateral adrenal hemorrhage in a man with severe COVID-19 pneumonia

Elkhouly, Mohamed M.N.; Elazzab, Ahmed A.; Moghul, Sakib

doi:10.1016/j.radcr.2021.03.032

Cited by 22 publications

(19 citation statements)

References 11 publications

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“…Evaluation of AI was done through CT findings, laboratory profiles, or both in 2 [ 24 , 28 ], 3 [ 17 , 18 , 31 ], and 2 [ 29 , 30 ] patients, respectively. Only one patient died [ 28 ], and all 6 others were discharged in stable condition with appropriate medical treatment [ 17 , 18 , 24 , 29 – 31 ]. 2 patients were followed up after hospital discharge with normal status [ 24 , 29 ].…”

Section: Resultsmentioning

confidence: 99%

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Adrenal Insufficiency in Coronavirus Disease 2019 (COVID-19)-Infected Patients without Preexisting Adrenal Diseases: A Systematic Literature Review

Vakhshoori

Heidarpour

Bondariyan

et al. 2021

International Journal of Endocrinology

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Background. Coronavirus disease 2019 (COVID-19) manifestations varied completely from its time of emergence. However, the assessment of adrenal insufficiency (AI) in this pandemic is lacking. In this review, we aimed to evaluate the status of AI among COVID-19-infected individuals. Methods. A systematic literature screening in PubMed/MEDLINE, Scopus, and Web of Science was performed until May 23, 2021. We collected relevant published peer-reviewed studies that reported AI occurrence in patients who suffered from COVID-19. Results. A total of 10 records (cross-sectional studies: 3, N = 256, males: 176 (68.7%), and case reports: 7, N = 7, males: 4 (57.1%)) were recruited. The age spectrum ranged from 22 to 96 years. AI was diagnosed with laboratory assessment or radiologic findings. The AI prevalence ranged from 3.1% to as high as 64.3% in different studies. Except for one patient, all other patients were discharged in stable conditions in published case reports. Conclusion. This review indicates that AI occurrence in the COVID-19 pandemic seems quite probable; however, the extent and type (primary, secondary, and functional) need to be clarified yet. Appropriate early diagnostic and therapeutic interventions should be done, especially in critically ill patients, to prevent lethal outcomes.

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Section: Resultsmentioning

confidence: 99%

“…e ages ranged from 44 to 70 years (males: 4). Evaluation of AI was done through CT findings, laboratory profiles, or both in 2 [24,28], 3 [17,18,31], and 2 [29,30] patients, respectively. Only one patient died [28], and all 6 others were discharged in stable condition with appropriate medical treatment [17,18,24,[29][30][31]].…”

Section: Case Report Studiesmentioning

confidence: 99%

Adrenal Insufficiency in Coronavirus Disease 2019 (COVID-19)-Infected Patients without Preexisting Adrenal Diseases: A Systematic Literature Review

Vakhshoori

Heidarpour

Bondariyan

et al. 2021

International Journal of Endocrinology

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“…The severe clinical picture is heterogeneous since multiple systems are damaged. For instance, in one case of a 50-year-old male, bilateral adrenal hemorrhage was first accidently detected at computed tomography (CT) scan for COVID-19 pneumonia, followed by clinical manifestation of adrenal insufficiency with hypotension, which was unfortunately followed by multiple thrombosis including massive pulmonary embolism [67]. This case also associates a prior diagnosis of adrenal tumor, which is exceptionally found until now in patients with COVID-19positive adrenal hemorrhage [67].…”

Section: Contributor Factorsmentioning

confidence: 96%

“…For instance, in one case of a 50-year-old male, bilateral adrenal hemorrhage was first accidently detected at computed tomography (CT) scan for COVID-19 pneumonia, followed by clinical manifestation of adrenal insufficiency with hypotension, which was unfortunately followed by multiple thrombosis including massive pulmonary embolism [67]. This case also associates a prior diagnosis of adrenal tumor, which is exceptionally found until now in patients with COVID-19positive adrenal hemorrhage [67]. Another 48-year-old male with a prior diagnosed of APLS who was under therapy with vitamin K antagonists at the moment of COVID-19 infection developed ischemia at the level of left toes due to artery occlusion, and he was synchronously diagnosed with adrenal hemorrhage before the switch was done for low-molecular-weight heparin (Enoxaparin) [68].…”

Section: Contributor Factorsmentioning

confidence: 99%

COVID-19 infection: from stress-related cortisol levels to adrenal glands infarction

Popescu

Terzea²,

Cârșote³

et al. 2022

Rom J Morphol Embryol

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Cortisol is a key element in acute stress including a severe infection. However, in coronavirus-associated disease, 20% of subjects experience hypocortisolemia due to direct or immune damage of pituitary and adrenal glands. One extreme form of adrenal insufficiency is found in 2/3 of cases with viral and post-viral adrenal infarction (AI) (with/without adrenal hemorrhage) that is mostly associated with a severe coronavirus disease 2019 (COVID-19) infection; it requires prompt glucocorticoid intervention. Some reports are incidental findings at computed tomography (CT)/magnetic resonance imaging (MRI) scans for non-adrenal complications like pulmonary spreading and others are seen on post-mortem analysis. This is a review of PubMed-accessible, English papers focusing on AI in addition to the infection, between March 1, 2020 and November 1, 2021. Exclusion criteria were acute adrenal insufficiency without the histopathological (HP) and/or imaging report of adrenal enlargement, necrosis, etc., respective adrenal failure due to pituitary causes, or non-COVID-19-related adrenal events. We identified a total of 84 patients (different levels of statistical evidence), as follows: a retrospective study on 51 individuals, two post-mortem studies comprising nine, respectively 12 patients, a case series of five subjects, seven single-case reports. HP aspects include necrosis associated with ischemia, cortical lipid degeneration (+/-focal adrenalitis), and infarcts at the level of adrenal cortex, blood clot into vessels, acute fibrinoid necrosis in arterioles and capsules, as well as subendothelial vacuolization. Collateral potential contributors to adrenal damage are thrombotic events, coagulation anomalies, antiphospholipid syndrome, endothelial dysfunction, severe COVID-19 infection with multiorgan failure, etc. Clinical picture is variable from acute primary adrenal insufficiency to asymptomatic or mild evolution, even a retrospective diagnostic; it may be a part of long COVID-19 syndrome; glucocorticoid therapy for non-adrenal considerations might mask cortisol deficient status due to AI/hemorrhage. Despite its rarity, the COVID-19-associated AI/hemorrhage represents a challenging new chapter, a condition that is essential to be recognized due to its gravity since prompt intervention with glucocorticoid replacement is lifesaving.

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“…Typically, adrenal haemorrhage was observed in patients with no known underlying adrenal lesions. [5][6][7] Adrenal insufficiency secondary to adrenal infarct has also been reported, although this predominantly occurred in patients with underlying antiphospholipid syndrome, predisposing patients to thrombotic events. 8,9 However, as the authors suggest, although these findings confirm histopathological evidence of the presence of the SARS-CoV-2 virus within the adrenal cortex in patients who died of COVID-19, the question remains regarding whether or not adrenocortical dysfunction contributes to the symptoms of long COVID in patients who survive the disease.…”

mentioning

confidence: 99%

Letter to the editor of clinical endocrinology: Assessment of adrenal function in patients who survive COVID‐19

Clarke

Phylactou

Patel

et al. 2022

Clinical Endocrinology

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Bilateral adrenal hemorrhage in a man with severe COVID-19 pneumonia

Cited by 22 publications

References 11 publications

Adrenal Insufficiency in Coronavirus Disease 2019 (COVID-19)-Infected Patients without Preexisting Adrenal Diseases: A Systematic Literature Review

Adrenal Insufficiency in Coronavirus Disease 2019 (COVID-19)-Infected Patients without Preexisting Adrenal Diseases: A Systematic Literature Review

COVID-19 infection: from stress-related cortisol levels to adrenal glands infarction

Letter to the editor of clinical endocrinology: Assessment of adrenal function in patients who survive COVID‐19

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