Adrenal crisis in a patient with APS2 due to COVID-19

Suryadevara, Varun; Merugu, Chandhana; Perumal, Nandhini Lakshmana; Sahoo, Jayaprakash; Kamalanathan, Sadishkumar; Naik, Dukhabandhu

doi:10.4103/jfmpc.jfmpc_1405_21

Cited by 4 publications

(4 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…145 Moreover, an adult male with APS-2 developed an adrenal crisis while going through COVID-19 infection. 146 A 14-year-old girl previously known with vitiligo was confirmed with adrenal crisis due to COVID-19 infection; she developed multisystem inflammatory syndrome in children (MIS-C), this being the first pediatric case of autoimmune AI and hypothyroidism that were diagnosed due to the infection. 147 Of note, a study analyzing medical deprivation rate in patients with endocrine disease during pandemic showed that individuals with AD had the lowest rate (of 0%) as opposed, for instance, with high rates for differentiated thyroid carcinoma (of 89%).…”

Section: Covid-19 Infection and Addison's Diseasementioning

confidence: 99%

See 1 more Smart Citation

Addison’s Disease: Diagnosis and Management Strategies

Cârșote¹,

Nistor²

2023

IJGM

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Covid-19 Infection and Addison's Diseasementioning

confidence: 99%

Addison’s Disease: Diagnosis and Management Strategies

Cârșote¹,

Nistor²

2023

IJGM

View full text Add to dashboard Cite

show abstract

“…In that case, an adolescent patient developed primary adrenal insufficiency and autoimmune hypothyroidism just weeks after presumed COVID-19 infection [ 10 ]. There also is a case report of adrenal crisis in APS-2 patients due to COVID [ 18 ], but other studies examining the occurrence of APS-2 with COVID-19 are lacking.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune Polyendocrinopathy in a Pediatric Patient Presenting With Multisystem Inflammatory Syndrome in Children (MIS-C)

Sambangi¹,

Collins²,

Chan³

et al. 2023

Cureus

View full text Add to dashboard Cite

Multisystem inflammatory syndrome (MIS) is a well-known potential sequela of COVID-19 infection. Though prevalence is higher in certain populations, this syndrome is a rare occurrence in children. Beyond MIS, there has been increasing research into COVID infection and the subsequent onset of autoimmune conditions, such as diabetes. However, evidence of a poly-endocrinopathy developing after COVID infection is lacking, and evidence within the pediatric population is virtually nonexistent. In this case, we present the evolution of an autoimmune polyglandular syndrome (APS) type 2 phenotype, consisting of type 1 diabetes, Graves' disease, and adrenal insufficiency, after diagnosis of multisystem inflammatory syndrome of children (MIS-C) in a pediatric patient. A 15-year-old biracial female without significant past medical history tested positive for COVID-19 and two weeks later presented with respiratory symptoms and other systemic signs. She was admitted for further evaluation and was found to have elevated inflammatory markers, EKG (electrocardiogram) abnormalities, and lab evidence of organ damage. The patient was diagnosed with MIS-C, and treatment was initiated with eventual discharge. One year after this initial visit, the patient returned to the hospital due to weight loss, difficulty breathing, polyuria, polydipsia, nausea, vomiting, and fatigue. A steroid course for MIS-C treatment had been completed three months prior. Exam and lab results confirmed diabetic ketoacidosis (DKA), and the patient was diagnosed with new-onset type 1 diabetes. Further testing determined that she was glutamic acid decarboxylase 65 (GAD-65) positive. DKA was managed in the hospital, and the patient was subsequently discharged with an insulin regimen and endocrine follow-up. A couple of months later, the patient returned to the emergency department (ED) due to two weeks of dyspnea on exertion and dizziness. Since her previous admission for DKA, the patient had contracted COVID-19 again and recovered from her respiratory symptoms. Physical exam and labs were grossly unremarkable; however, the patient had EKG abnormalities and an episode of severe bradycardia, prompting hospitalization. Thyroid workup revealed thyrotoxicosis due to Graves' disease. Due to intermittent hypotension, adrenal labs were obtained. She was found to have adrenal insufficiency as well, with a positive 21-hydroxylase antibody. Throughout these hospitalizations, the patient suffered from skin and hair changes as well, ultimately requiring dermatological intervention.

show abstract

“…There is some controversy as to whether patients with primary or secondary adrenal insufficiency, including OIAI, have an elevated risk of contracting COVID-19 and face a greater risk of a complicated course, because the infection may trigger a possibly lifethreatening adrenal crisis [38][39][40][41]. In cases of a patient with both COVID-19 and OIAI, an increased dose of glucocorticoid replacement therapy is recommended [38].…”

Section: Adrenal Insufficiency In the Covid Eramentioning

confidence: 99%

A Closer Look at Opioid-Induced Adrenal Insufficiency: A Narrative Review

Coluzzi

LeQuang

Sciacchitano

et al. 2023

IJMS

View full text Add to dashboard Cite

Among several opioid-associated endocrinopathies, opioid-associated adrenal insufficiency (OIAI) is both common and not well understood by most clinicians, particularly those outside of endocrine specialization. OIAI is secondary to long-term opioid use and differs from primary adrenal insufficiency. Beyond chronic opioid use, risk factors for OIAI are not well known. OIAI can be diagnosed by a variety of tests, such as the morning cortisol test, but cutoff values are not well established and it is estimated that only about 10% of patients with OIAI will ever be properly diagnosed. This may be dangerous, as OIAI can lead to a potentially life-threatening adrenal crisis. OIAI can be treated and for patients who must continue opioid therapy, it can be clinically managed. OIAI resolves with opioid cessation. Better guidance for diagnosis and treatment is urgently needed, particularly in light of the fact that 5% of the United States population has a prescription for chronic opioid therapy.

show abstract

Adrenal crisis in a patient with APS2 due to COVID-19

Cited by 4 publications

References 11 publications

Addison’s Disease: Diagnosis and Management Strategies

Addison’s Disease: Diagnosis and Management Strategies

Autoimmune Polyendocrinopathy in a Pediatric Patient Presenting With Multisystem Inflammatory Syndrome in Children (MIS-C)

A Closer Look at Opioid-Induced Adrenal Insufficiency: A Narrative Review

Contact Info

Product

Resources

About