Bilateral Adrenal Hemorrhage in Coronavirus Disease 2019 Patient: A Case Report

Frankel, Meir; Feldman, Itamar; Levine, Michal A.; Frank, Y.; Bogot, Naama; Benjaminov, Ofer; Kurd, Ramzi; Breuer, Gabriel S.; Munter, Gabriel

doi:10.1210/clinem/dgaa487

Cited by 74 publications

(69 citation statements)

References 12 publications

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“…According to patient’s history of recurrent abortions, the presence of antiphospholipid antibody syndrome (APLS) was also suspected and confirmed by specific antibody assays. Hence, authors hypothesized that the combination of both COVID-19 infection and APLS was responsible for adrenal failure [ 97 ]. Another case is a 70-year-old man, with a history of psoriasis, hospitalized with persistent lower back pain resistant to medical treatment.…”

Section: Resultsmentioning

confidence: 99%

Relationship between betacoronaviruses and the endocrine system: a new key to understand the COVID-19 pandemic—A comprehensive review

Piticchio

Moli

Tumino

et al. 2021

J Endocrinol Invest

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Background A new harmful respiratory disease, called COVID-19 emerged in China in December 2019 due to the infection of a novel coronavirus, called SARS-Coronavirus 2 (SARS-CoV-2), which belongs to the betacoronavirus genus, including SARS-CoV-1 and MERS-CoV. SARS-CoV-2 shares almost 80% of the genome with SARS-CoV-1 and 50% with MERS-CoV. Moreover, SARS-CoV-2 proteins share a high degree of homology (approximately 95%) with SARS-CoV-1 proteins. Hence, the mechanisms of SARS-Cov-1 and SARS-Cov-2 infection are similar and occur via binding to ACE2 protein, which is widely distributed in the human body, with a predominant expression in endocrine tissues including testis, thyroid, adrenal and pituitary. Purpose On the basis of expression pattern of the ACE2 protein among different tissues, similarity between SARS-Cov-1 and SARS-Cov-2 and the pathophysiology of COVID-19 disease, we aimed at discussing, after almost one-year pandemic, about the relationships between COVID-19 infection and the endocrine system. First, we discussed the potential effect of hormones on the susceptibility to COVID-19 infection; second, we examined the evidences regarding the effect of COVID-19 on the endocrine system. When data were available, a comparative discussion between SARS and COVID-19 effects was also performed. Methods A comprehensive literature search within Pubmed was performed. This review has been conducted according to the PRISMA statements. Results Among 450, 100 articles were selected. Tissue and vascular damages have been shown on thyroid, adrenal, testis and pituitary glands, with multiple alterations of endocrine function. Conclusion Hormones may affect patient susceptibility to COVID-19 infection but evidences regarding therapeutic implication of these findings are still missing. SARS and COVID-19 may affect endocrine glands and their dense vascularization, impairing endocrine system function. A possible damage of endocrine system in COVID-19 patients should be investigated in both COVID-19 acute phase and recovery to identify both early and late endocrine complications that may be important for patient’s prognosis and well-being after COVID-19 infection.

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Section: Resultsmentioning

confidence: 99%

Relationship between betacoronaviruses and the endocrine system: a new key to understand the COVID-19 pandemic—A comprehensive review

Piticchio

Moli

Tumino

et al. 2021

J Endocrinol Invest

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“…COVID-19 was associated with the flares of pre-existing APS. The complications include bilateral adrenal glands hemorrhage in a 66-year-old female and limb ischemia in another 48-yearold male, both of which were controlled by anticoagulants (58,59). Interestingly, one study revealed 5 (63%) of eight pregnant women with COVID-19 infection fulfilled diagnostic criteria for pre-eclampsia/HELLP syndrome (hemolysis; elevated liver enzymes; low platelet count), perhaps due to overlapping features.…”

Section: Antiphospholipid Antibody Syndrome (Aps)mentioning

confidence: 99%

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

2021

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Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations.Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years.Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis.Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.

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“…Imaging confirmed a small filling defect in the left renal vein consistent with a non-obstructing thrombus. 5 A further recently published case report describes non-haemorrhagic adrenal infarction in a patient with COVID-19 infection who presented with abdominal pain and hyponatraemia. 6 To our knowledge, we report the first case of a clinically occult unilateral AH to present in a patient with confirmed COVID-19 infection in the absence of abdominal symptoms or clinical signs of adrenal insufficiency.…”

Section: Discussionmentioning

confidence: 98%

Adrenal haemorrhage as a complication of COVID-19 infection

et al. 2020

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We report an unusual complication of COVID-19 infection in a 53-year-old Caucasian man. He presented with shortness of breath, fever and pleuritic chest pain. A CT pulmonary angiogram (CTPA) demonstrated acute bilateral pulmonary embolism and bilateral multifocal parenchymal ground glass change consistent with COVID-19 (SARS-CoV-2) infection. Right adrenal haemorrhage was suspected on the CTPA which was confirmed on triple-phase abdominal CT imaging. A short Synacthen test revealed normal adrenal function. He was treated initially with an intravenous heparin infusion, which was changed to apixaban with a planned outpatient review in 3 months’ time. He made an uncomplicated recovery and was discharged. Follow-up imaging nearly 5 months later showed near complete resolution of the right adrenal haemorrhage with no CT evidence of an underlying adrenal lesion.

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Bilateral Adrenal Hemorrhage in Coronavirus Disease 2019 Patient: A Case Report

Cited by 74 publications

References 12 publications

Relationship between betacoronaviruses and the endocrine system: a new key to understand the COVID-19 pandemic—A comprehensive review

Relationship between betacoronaviruses and the endocrine system: a new key to understand the COVID-19 pandemic—A comprehensive review

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

Adrenal haemorrhage as a complication of COVID-19 infection

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