Spontaneous adrenal haemorrhage in pregnancy and review of the literature

Patel, Ekta; Zill‐E‐Huma, Rabia; Demertzidou, Eleftheria

doi:10.1136/bcr-2021-246240

Cited by 1 publication

(1 citation statement)

References 12 publications

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“…During acute stress, the general biochemistry and endocrine panel includes increased traditional biomarkers of inflammation (like fibrinogen, Creactive protein), changes of leptin, adrenalin, procalcitonin, ferritin, lactate dehydrogenase levels, a new dynamics of interleukins (ILs) profile, etc. [24,25]. Other data particularly concerning COVID-19 infection, showed, for instance, as cortisol associates with inflammation markers, so is total testosterone and calculated free testosterone in females with pneumonia due to more intense adrenal cortex activity [26].…”

Section: Cortisol As Stress Hormonementioning

confidence: 98%

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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Section: Cortisol As Stress Hormonementioning

confidence: 98%