Acute adrenal infarction as an incidental CT finding and a potential prognosis factor in severe SARS-CoV-2 infection: a retrospective cohort analysis on 219 patients

Abstract

Objectives To retrospectively investigate the incidence of acute adrenal infarction (AAI) in patients who underwent chest CT for severe SARS-CoV-2 infection and to correlate findings with prognosis. Methods The local ethics committee approved this retrospective study and waived the need of informed consent. From March 9 to April 10, 2020, all patients referred to our institution for a clinical suspicion of COVID-19 with moderate to severe symptoms underwent a chest CT for triage. Patients with a/parenchymal lesion characteristics of COVID-19 involving at least 50% of lung parenchyma and b/positive RT-PCR for SARS-CoV-2 were retrospectively included. Adrenal glands were reviewed by two independent readers to look for AAI. Additional demographics and potential biological markers of adrenal insufficiency were obtained. Correlations with ICU stay and mortality were sought. Results Out of the 219 patients with critical (n = 52) and severe lung (n = 167) parenchyma lesions, 51 (23%) had CT scan signs of AAI, which was bilateral in 45 patients (88%). Four patients had an acute biological adrenal gland insufficiency (8%). Univariate analysis in AAI+ patients demonstrated a higher rate of ICU stay (67% vs. 45%, p < 0.05) and a longer stay (more than 15 days for 31% for AAI+ vs. 19%, p < 0.05) compared with AAI− patients. Mortality rate was similar (27%, p = 0.92). Conclusions Acute adrenal infarction on initial chest evaluation of severe COVID-19 is frequent (51/219, 23%) and might be a sign of poorer prognosis. Key Points • Acute adrenal infarction on initial chest CT evaluation of severe COVID-19 is frequent (51/219). • AAI might be a factor of poorer prognosis, with increased rate of ICU hospitalization and length of stay.

COVID-19 vasculitis and novel vasculitis mimics

“… 85 , 86 Studies have also reported liver and adrenal infarction in a few cases, indicating compromised arterial blood supply. 87 The source of embolisation in the pulmonary venular territory leading to a vasculitis mimic would be expected to involve arterial tree divisions only and is distinct from systemic venous thrombosis as a cause of tissue damage, which has been reported in organs such as the heart ( table 2 ). 88 …”

Tele-medicine versus face-to-face consultation in Endocrine Outpatients Clinic during COVID-19 outbreak: a single-center experience during the lockdown period

“…COVID-19 treatment might induce endocrine complications, as adrenal insufficiency secondary to the high-dose glucocorticoid treatment, which is sometimes used in patients with severe disease [11,12]. SARS-CoV-2-related subacute thyroiditis may be an underestimated manifestation of COVID-19 [13], and adrenal infarction can represent a factor of poorer prognosis [14]. Recently, dexamethasone has been reported effective to reduce 28-day mortality among patients receiving invasive mechanical ventilation or oxygen at randomization [15].…”

Delayed Onset of Central Hypocortisolism in a Patient Recovering From COVID-19

“…New-onset hypocortisolism has been reported in a patient with severe COVID-19 who presented with vasopressor-refractory hypotension; however, its etiology was unclear as data on ACTH levels was not available. 1 In a retrospective study of 219 patients with severe COVID-19, radiological evidence of acute adrenal infarction was noted in 23% of the patients; among these, 8% had biochemical hypocortisolism 2 . Several mechanisms have been proposed, including a cytokine storm with increased production of pro-inflammatory cytokines such as tumor necrosis factor-α, which leads to decreased ACTH release and impaired function of ACTH and angiotensin-2 on adrenal cells.…”