COVID‐19‐related adrenal haemorrhage: Multicentre UK experience and systematic review of the literature

Elhassan, Yasir S; Iqbal, Fizzah; Arlt, Wiebke; Baldeweg, Stephanie; Levy, Miles; Stewart, Paul M.; Wass, John; Pavord, Sue; Rees, Dafydd Aled; Ronchi, Cristina L.

doi:10.1111/cen.14881

Cited by 12 publications

(10 citation statements)

References 42 publications

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“…Of the 18 cases included in the study, seven patients had infection-related adrenal hemorrhage. The median time from a positive COVID-19 test to the development of adrenal hemorrhage was eight days (range = 1-30) [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Vanishing Adrenal Glands: Bilateral Adrenal Hemorrhage With Adrenal Insufficiency in COVID-19 Infection

Majety¹,

Erlikh²,

Hou³

2023

Cureus

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Coronavirus disease 2019 (COVID-19) has been associated with thrombotic and endocrine complications, including adrenal insufficiency in the setting of adrenal hemorrhage. We present a patient diagnosed with antiphospholipid syndrome (APLS) in the setting of COVID-19 infection resulting in bilateral adrenal hemorrhage, subsequently leading to adrenal insufficiency. Acute adrenal hemorrhage is an underrecognized cause of decompensation, multisystem failure, and death in severe illness. Reports of adrenal insufficiency in the setting of COVID-19 infection revealed microscopic infarction, which can increase the risk of hemorrhage. Other mechanisms include severe hyperinflammatory response and cytokine storm leading to endothelial dysfunction, vascular injury, adrenal parenchymal damage, and hemorrhage. COVID-19 infection can be associated with coagulopathy and thromboembolic events and can lead to adrenal hemorrhage. Adrenal insufficiency is life-threatening and needs to be recognized promptly. There can be a latent phase between hemorrhagic events and adrenal failure; hence, close monitoring and timely intervention are important.

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Section: Discussionmentioning

confidence: 99%

Vanishing Adrenal Glands: Bilateral Adrenal Hemorrhage With Adrenal Insufficiency in COVID-19 Infection

Majety¹,

Erlikh²,

Hou³

2023

Cureus

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“…To our knowledge, seventeen cases of adrenal bleeding following COVID-19 vaccination have been reported to date [121][122][123][124][125][126][127][128][129][130][131][132][133]. Four were unpublished but reported in a systematic review and survey from the UK [133]. All the cases reported occurred after viral vector-based vaccines, except two following the BNT162b2 SARS-CoV-2 mRNA vaccine [133].…”

Section: Adrenal Glands and Sars-cov-2 Vaccinementioning

confidence: 98%

“…Four were unpublished but reported in a systematic review and survey from the UK [133]. All the cases reported occurred after viral vector-based vaccines, except two following the BNT162b2 SARS-CoV-2 mRNA vaccine [133]. The main findings of these studies are summarized in supplementary Table 3.…”

Section: Adrenal Glands and Sars-cov-2 Vaccinementioning

confidence: 99%

“…On the other hand, adrenal hemorrhage with eventually subsequent adrenal crisis has been reported in the context of vaccine-induced thrombotic thrombocytopenia (VITT). To our knowledge, seventeen cases of adrenal bleeding following COVID-19 vaccination have been reported to date [121][122][123][124][125][126][127][128][129][130][131][132][133]. Four were unpublished but reported in a systematic review and survey from the UK [133].…”

Section: Adrenal Glands and Sars-cov-2 Vaccinementioning

confidence: 99%

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SARS-CoV-2 Vaccines-Related Endocrine Disorders: An Updated Narrative Review

Ishay,

Oleinikov,

Shacham

2024

Preprint

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The emergence of the COVID-19 pandemic has led to the rapid and worldwide devel-opment and investigation of multiple vaccines. While most side effects of these vaccines are mild and transient, potentially severe adverse events may occur and involve the endocrine system. This narrative review aims to explore the current knowledge on potential endocrine adverse effects following COVID-19 vaccination, with thyroid disorders being the most common. Data about pi-tuitary, adrenal, diabetes, and gonadal events will also be reviewed. This review also provides a comprehensive understanding of the pathogenesis of endocrine disorders associated with SARS-CoV-2 vaccines. A PubMed/MEDLINE, Embase database (Elsevier), and Google Scholar research were performed. Case reports case series, original studies, and reviews written in English and published online up to 31 August 2023 were selected and reviewed. Data on endocrine adverse events of SARS-CoV-2 vaccines is accumulating. However, their causal relationship with COVID-19 vaccines is not strong enough to make a definite conclusion, and further studies are needed to clarify the pathogenesis mechanisms of endocrine disorders linked to COVID-19 vac-cines.

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“…Recently, Elhassan et al performed a systematic literature review and, concomitantly, conducted a survey through the Society for Endocrinology clinical membership to identify patients with COVID‐19‐related adrenal hemorrhage using a standardized data collection tool. The literature search yielded 13 cases of COVID‐19 infection‐related adrenal hemorrhage/infarction (10 bilateral) and the UK survey captured 4 additional cases (2 bilateral) [ 13 ].…”

Section: Covid-19 and Adrenal Tropismmentioning

confidence: 99%

COVID-19 pandemic and adrenals: deep insights and implications in patients with glucocorticoid disorders

et al. 2023

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Purpose Coronavirus disease-19 (COVID-19) has spread throughout the world. It was initially defined as a potentially severe syndrome affecting the respiratory tract, but it has since been shown to be a systemic disease with relevant extrapulmonary manifestations that increase mortality. The endocrine system has been found to be vulnerable to COVID-19 infection. The current review aims to evaluate the available data on the impact of COVID-19 infection and treatment, as well as COVID-19 vaccines, on adrenal gland function, particularly in patients with GC disorders. Methods A thorough search of published peer-reviewed studies in PubMed was performed using proper keywords. Results Adrenal viral tropism and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication in the adrenal glands have been demonstrated, and adrenal insufficiency (AI) is a rare, but potentially severe complication in COVID-19 disease, whose recognition can be difficult if only for the empirical treatments administered in the early stages. Glucocorticoid (GC) treatment have had a pivotal role in preventing clinical deterioration in patients with COVID-19, but long-term GC use may increase COVID-19-related mortality and the development of iatrogenic AI. Patients with GC disorders, especially AI and Cushing’s syndrome, have been identified as being at high risk of COVID-19 infection and complications. Published evidence suggests that AI patient awareness and proper education may help adjust GC replacement therapy appropriately when necessary, thereby reducing COVID-19 severity. The COVID-19 pandemic has had an impact on AI management, particularly in terms of adherence to patients’ care plans and self-perceived challenges. On the other hand, published evidence suggests that the clinical course of COVID-19 may be affected by the severity of hypercortisolism in patients with CS. Therefore, to ameliorate the risk profile in these patients, cortisol levels should be adequately controlled, along with careful monitoring of metabolic and cardiovascular comorbidities. To date, the COVID-19 vaccine remains the only available tool to face SARS-CoV-2, and it should not be treated differently in patients with AI and CS. Conclusion SARS-CoV-2 infection has been linked to adrenal damage and AI is a rare complication in COVID-19 disease, requiring prompt recognition. Educational efforts and patient awareness may reduce COVID-19 severity in patients with AI. Control of cortisol levels and monitoring of complications may improve the clinical course of COVID-19 in patients with CS.

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COVID‐19‐related adrenal haemorrhage: Multicentre UK experience and systematic review of the literature

Cited by 12 publications

References 42 publications

Vanishing Adrenal Glands: Bilateral Adrenal Hemorrhage With Adrenal Insufficiency in COVID-19 Infection

Vanishing Adrenal Glands: Bilateral Adrenal Hemorrhage With Adrenal Insufficiency in COVID-19 Infection

SARS-CoV-2 Vaccines-Related Endocrine Disorders: An Updated Narrative Review

COVID-19 pandemic and adrenals: deep insights and implications in patients with glucocorticoid disorders

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