Case Report: Adrenal Pathology Findings in Severe COVID-19: An Autopsy Study

Santana, Monique Freire; Borba, Mayla Gabriela Silva; Baía-da-Silva, Djane Clarys; Val, Fernando; Alexandre, Márcia A. A.; Brito-Sousa, José Diego; Melo, Gisely Cardoso de; Queiroga, Marcos Vinícius Oliveira; Farias, Maria Eduarda Leão de; Camilo, Cecília Cunha; Naveca, Felipe Gomes; Xavier, Mariana Simão; Monteiro, Wuelton Marcelo; João, Guilherme Augusto Pivoto; Hajjar, Ludhmila Abrahão; Ordï, Jaume; Lacerda, Marcus Vinícius Guimarães; Ferreira, Luíz Carlos Lima

doi:10.4269/ajtmh.20-0787

Cited by 83 publications

(55 citation statements)

References 17 publications

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“…In the previous outbreak of SARS in 2003, autopsy studies have identified the virus in the adrenal cortical cells and showed that the cells underwent degeneration and necrosis, suggesting a direct cytopathic effect of the virus(28, 29). Similar changes in the adrenal cortex in autopsy studies have just been shown during the current epidemic of COVID-19 ( 30 ). In a recent autopsy study, microscopic changes were observed in examination of the adrenal glands in 12 of 28 patients studied (46%)( 30 ).…”

Section: Discussionsupporting

confidence: 77%

“…Similar changes in the adrenal cortex in autopsy studies have just been shown during the current epidemic of COVID-19 ( 30 ). In a recent autopsy study, microscopic changes were observed in examination of the adrenal glands in 12 of 28 patients studied (46%)( 30 ). Seven cases showed cortical necrosis, four showed cortical lipid degeneration; two showed hemorrhage; and one nonspecific focal adrenalitis.…”

Section: Discussionsupporting

confidence: 77%

“…Vascular thrombosis was seen in one patient and focal inflammation in three patients. Interestingly, none of these patients had adrenal insufficiency ( 30 ) Another autopsy study of 10 patients with COVID-19 showed adrenal microinfarcations in 3 patients (33.3%) ( 31 ). A recent report has just been published on bilateral adrenal hemorrhage leading to acute adrenal insufficiency in a 66-year old woman who presented with COVID-19 infection and was known to have antiphospholipid syndrome ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

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The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis

et al. 2021

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis

et al. 2021

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“…Hence, patients with COVID-19 infection may be susceptible to corticosteroid insufficiency (CIRCI) due to both direct viral adrenal cell damage and adrenal inflammatory/autoimmune processes. The variability of microscopic alterations induced by SARS-CoV-2 on human adrenals was confirmed by a recent study from Freire Santana et al They performed autoptic analysis in 28 COVID patients and observed microscopic lesions in the adrenal glands of 12 out 28 patients (46%): seven showed ischemic necrosis; four cortical lipid degeneration; two haemorrhage; one unspecific focal adrenalitis; one vascular thrombosis; three focal inflammation along with the other findings [ 95 ]. However, further studies will be required to prove the presence of SARS-CoV-2 in adrenal tissue and define the mechanisms of adrenal degeneration and loss of function.…”

Section: Resultsmentioning

confidence: 78%

Relationship between betacoronaviruses and the endocrine system: a new key to understand the COVID-19 pandemic—A comprehensive review

Piticchio

Moli

Tumino

et al. 2021

J Endocrinol Invest

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Background A new harmful respiratory disease, called COVID-19 emerged in China in December 2019 due to the infection of a novel coronavirus, called SARS-Coronavirus 2 (SARS-CoV-2), which belongs to the betacoronavirus genus, including SARS-CoV-1 and MERS-CoV. SARS-CoV-2 shares almost 80% of the genome with SARS-CoV-1 and 50% with MERS-CoV. Moreover, SARS-CoV-2 proteins share a high degree of homology (approximately 95%) with SARS-CoV-1 proteins. Hence, the mechanisms of SARS-Cov-1 and SARS-Cov-2 infection are similar and occur via binding to ACE2 protein, which is widely distributed in the human body, with a predominant expression in endocrine tissues including testis, thyroid, adrenal and pituitary. Purpose On the basis of expression pattern of the ACE2 protein among different tissues, similarity between SARS-Cov-1 and SARS-Cov-2 and the pathophysiology of COVID-19 disease, we aimed at discussing, after almost one-year pandemic, about the relationships between COVID-19 infection and the endocrine system. First, we discussed the potential effect of hormones on the susceptibility to COVID-19 infection; second, we examined the evidences regarding the effect of COVID-19 on the endocrine system. When data were available, a comparative discussion between SARS and COVID-19 effects was also performed. Methods A comprehensive literature search within Pubmed was performed. This review has been conducted according to the PRISMA statements. Results Among 450, 100 articles were selected. Tissue and vascular damages have been shown on thyroid, adrenal, testis and pituitary glands, with multiple alterations of endocrine function. Conclusion Hormones may affect patient susceptibility to COVID-19 infection but evidences regarding therapeutic implication of these findings are still missing. SARS and COVID-19 may affect endocrine glands and their dense vascularization, impairing endocrine system function. A possible damage of endocrine system in COVID-19 patients should be investigated in both COVID-19 acute phase and recovery to identify both early and late endocrine complications that may be important for patient’s prognosis and well-being after COVID-19 infection.

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“…Under these conditions, cytokines may act individually or via additive or synergistic mechanisms to modulate responses (e.g., margination, apoptosis) of circulating, recruited, and/or tissue-resident eosinophils. Interestingly, stress-based cortisol responses which in other circumstances might lead to eosinopenia [ 64 ] are impaired in moderate-to-severe COVID-19 [ 65 – 68 ].…”

Section: Eosinopenia and The Role Of Eosinophils In Covid-19mentioning

confidence: 99%

Eosinophils and COVID-19: diagnosis, prognosis, and vaccination strategies

Rosenberg

Foster

2021

Semin Immunopathol

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The unprecedented impact of the coronavirus disease 2019 (COVID-19) pandemic has resulted in global challenges to our health-care systems and our economic security. As such, there has been significant research into all aspects of the disease, including diagnostic biomarkers, associated risk factors, and strategies that might be used for its treatment and prevention. Toward this end, eosinopenia has been identified as one of many factors that might facilitate the diagnosis and prognosis of severe COVID-19. However, this finding is neither definitive nor pathognomonic for COVID-19. While eosinophil-associated conditions have been misdiagnosed as COVID-19 and others are among its reported complications, patients with pre-existing eosinophil-associated disorders (e.g., asthma, eosinophilic gastrointestinal disorders) do not appear to be at increased risk for severe disease; interestingly, several recent studies suggest that a diagnosis of asthma may be associated with some degree of protection. Finally, although vaccine-associated aberrant inflammatory responses, including eosinophil accumulation in the respiratory tract, were observed in preclinical immunization studies targeting the related SARS-CoV and MERS-CoV pathogens, no similar complications have been reported clinically in response to the widespread dissemination of either of the two encapsulated mRNA-based vaccines for COVID-19.

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Case Report: Adrenal Pathology Findings in Severe COVID-19: An Autopsy Study

Cited by 83 publications

References 17 publications

The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis

The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis

Relationship between betacoronaviruses and the endocrine system: a new key to understand the COVID-19 pandemic—A comprehensive review

Eosinophils and COVID-19: diagnosis, prognosis, and vaccination strategies

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