Primary adrenal insufficiency and myocarditis in COVID-19 disease: a case report

Eskandari, Delaram; Ziaee, Amir; Amirfarhangi, Abdollah; Zeinali, Elahe; Tirkan, Atefe

doi:10.1186/s12902-022-01257-3

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…One teenager with coronavirus-associated myocarditis was identified with AD due to this trigger infection. 142 One male in his 20s was confirmed with AD while being identified COVID-19 positive. This is the first case of AD in a patient with a history of autoimmune disseminated encephalomyelitis that experienced the coronavirus infection.…”

Section: Discussionmentioning

confidence: 97%

Addison’s Disease: Diagnosis and Management Strategies

Cârșote¹,

Nistor²

2023

IJGM

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We aim to overview Addison’s disease (AD) with regard to current diagnosis and management. This is a narrative review of full-length articles published in English between January 2022 and December 2022 (including online ahead of print versions) in PubMed-indexed journals. We included original studies in living humans regardless of the level of statistical significance starting from the key search terms “Addison’s disease” or “primary adrenal insufficiency” in title or abstract. We excluded articles with secondary adrenal insufficiency. Briefly, 199 and 355 papers, respectively were identified; we manually checked each of them, excluded the duplicates, and then selected 129 based on their clinical relevance in order to address our 1-year analysis. We organized the data in different subsections covering all published aspects on the subject of AD. To our knowledge, this is the largest AD retrospective from 2022 on published data. A massive role of genetic diagnosis especially in pediatric cases is highlighted; the importance of both pediatric and adult awareness remains since unusual presentations continue to be described. COVID-19 infection is a strong player amid this third year of pandemic although we still not do have large cohorts in this particular matter as seen, for instance, in thyroid anomalies. In our opinion, the most important topic for research is immune checkpoint inhibitors, which cause a large panel of endocrine side effects, AD being one of them.

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Section: Discussionmentioning

confidence: 97%

Addison’s Disease: Diagnosis and Management Strategies

Cârșote¹,

Nistor²

2023

IJGM

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“…Primary hypocortisolism has also been reported in COVID-19 patients. Details of previously reported cases of pituitary dysfunction and primary hypocortisolism occurring more than 2 weeks after SARS-CoV-2 infection are shown in Table 4 ( 17 – 23 , 25 , 27 , 28 ). The findings from those studies are consistent with our own results and support the conclusion that pituitary and adrenal function may be affected by SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 99%

The existence of adrenal insufficiency in patients with COVID-19 pneumonia

Porntharukchareon,

Dechates,

Sirisreetreerux

et al. 2024

Front. Endocrinol.

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IntroductionInfection with SARS-CoV-2 virus may result in long COVID, a syndrome characterized by symptoms such as dyspnea, cardiac abnormalities, cognitive impairment, and fatigue. One potential explanation for these symptoms is hypocortisolism.ObjectiveTo evaluate the prevalence of hypocortisolism in patients with a history of COVID-19 pneumonia.MethodsCross-sectional study of patients who were aged ≥18 years and had a 3-month history of radiography-confirmed COVID-19 pneumonia. Exclusion criteria included current or previous treatment with glucocorticoids and use of an oral contraceptive. Adrenal function was evaluated using a low dose (1ug) corticotropin stimulation test (CST). Serum cortisol levels were measured at 0, 30, and 60 minutes, and baseline plasma ACTH was also measured.ResultsOf the 41 patients enrolled, the median age was 62 years, 17 (42%) were female, and all 41 (100%) had severe pneumonia at baseline. Eleven patients (27%) had hypocortisolism, as evidenced by peak cortisol of less than 402.81 nmol/l after low dose (1 µg) CST. Of these 11 patients, 10 (91%) had secondary hypocortisolism (median ACTH 6.27 pmol/L, range 4.98–9.95 pmol/L) and one had primary hypocortisolism (mean ACTH 32.78 pmol/L). Six of the 11 patients with hypocortisolism (54.5%) reported symptoms of persistent fatigue and 5 (45.5%) required regular glucocorticoid replacement.ConclusionsOur results suggest that hypocortisolism, predominantly caused by pituitary disruption, may emerge after SARS-CoV-2 infection and should be considered in patients with a history of COVID-19 pneumonia with or without clinical hypocortisolism.

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“…Individuals with COVID-19 who are critically ill have been found to have lower cortisol levels compared to critically ill patients without COVID-19, and adrenal insufficiency has been reported in the setting of COVID-19. However, it remains unclear whether the hypocortisolism is due to primary infection of the adrenal gland with SARS-CoV-2 or to dysfunction of the hypothalamic pituitary axis [ 43 , 48 – 50 ]. COVID-19 vaccines have been associated rarely with endocrine side effects, particularly in thyroid disorders with involvement of the adrenal gland being anecdotal [ 51 ].…”

Section: Infectious Diseases In Endocrine Organs: a Pathological Poin...mentioning

confidence: 99%

Inflammatory and Infectious Disorders in Endocrine Pathology

et al. 2023

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A variety of inflammatory conditions may directly involve the endocrine glands, leading to endocrine dysfunction that can cause severe consequences on patients’ health, if left untreated. Inflammation of the endocrine system may be caused by either infectious agents or other mechanisms, including autoimmune and other immune-mediated processes. Not infrequently, inflammatory and infectious diseases may appear as tumor-like lesions of endocrine organs and simulate neoplastic processes. These diseases may be clinically under-recognized and not infrequently the diagnosis is suggested on pathological samples. Thus, the pathologist should be aware of the basic principles of their pathogenesis, as well as of their morphological features, clinicopathological correlates, and differential diagnosis. Interestingly, several systemic inflammatory conditions show a peculiar tropism to the endocrine system as a whole. In turn, organ-specific inflammatory disorders are observed in endocrine glands. This review will focus on the morphological aspects and clinicopathological features of infectious diseases, autoimmune disorders, drug-induced inflammatory reactions, IgG4-related disease, and other inflammatory disorders involving the endocrine system. A mixed entity-based and organ-based approach will be used, with the aim to provide the practicing pathologist with a comprehensive and practical guide to the diagnosis of infectious and inflammatory disorders of the endocrine system.

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Primary adrenal insufficiency and myocarditis in COVID-19 disease: a case report

Cited by 5 publications

References 18 publications

Addison’s Disease: Diagnosis and Management Strategies

Addison’s Disease: Diagnosis and Management Strategies

The existence of adrenal insufficiency in patients with COVID-19 pneumonia

Inflammatory and Infectious Disorders in Endocrine Pathology

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