Case Report: COVID-19 with Bilateral Adrenal Hemorrhage

Álvarez-Troncoso, Jorge; Larrauri, M; Vega, María Dolores Montero; Vallano, Rebeca Gil; Peláez, Esmeralda Palmier; Rojas-Marcos, Patricia Martín; Martín-Luengo, Fátima; Campo, Paula Lázaro del; Gil, Carmen Rosario Herrero; Esteban, E.

doi:10.4269/ajtmh.20-0722

Cited by 37 publications

(37 citation statements)

References 8 publications

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“…Finally, this case series besides other intraperitoneal bleeding reports in COVID-19 patients [10,11,20,21] demonstrated that COVID-19 coagulopathy and AT should be studied more. To reduce the disease mortality and morbidity investigations on the pathophysiology of COVID-19-associated coagulopathy and finding the best intervention to prevent or treat it is needed.…”

Section: Discussionsupporting

confidence: 54%

“…Hemophagocytic lymphohistiocytosis (HLH) could cause coagulation disorders leading to hemorrhage [ 6 ] and there is some evidence that hyper-inflammation state could induce HLH in COVID-19 patients [ 7 ], but clinical manifestation and laboratory markers (fever, splenomegaly, decreased counts in two cell lines, hypertriglyceridemia and/or hypofibrinogenemia, and hemophagocytosis) of our patients did not make this diagnosis as the H-score for our patient were less than 90. Catastrophic APS is a rare autoimmune disease that could cause coagulation disturbance by increasing aPTT and there is some controversial evidence about its occurrence in critically ill patients with COVID-19 [ 8 , 9 ]; there are also two cases of COVID-19 bilateral adrenal hemorrhage that one of them had a history of antiphospholipid syndrome and the other one had a suspected history of autoimmune diseases [ 10 , 11 ], however, unfortunately, we did not check markers of this disease but none of our patients developed notable prolonged PTT.…”

Section: Discussionmentioning

confidence: 99%

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Massive intraperitoneal hemorrhage in patients with COVID-19: a case series

Reisi-Vanani

Lorigooini

Dayani

et al. 2021

J Thromb Thrombolysis

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Coronavirus disease (COVID-19) initiates several life-threatening complications including coagulopathies with a unique characteristic that made this problem challenging. Here we presented 4 cases of RT-PCR positive patients that have experienced deadly intraperitoneal hemorrhage with fourth WHO Bleeding Grade after overcoming their respiratory phase. COVID-19 could induce several coagulopathies with different features that besides iatrogenic interventions increases its mortality and morbidity due to lack of clinical evidence based on well-designed randomized clinical trials on anticoagulation therapies (AT) and administration of varieties of newly approved and non-approved medicines. This report showed the urgent need for investigation on the pathophysiology of COVID-19-associated coagulopathy esp. in hemorrhagic events which are needed to make the best therapeutic decision.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Massive intraperitoneal hemorrhage in patients with COVID-19: a case series

Reisi-Vanani

Lorigooini

Dayani

et al. 2021

J Thromb Thrombolysis

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“…The patient was positive for COVID-19 IgG and IgM. Both basal cortisol and stimulated confirmed the diagnosis of adrenal insufficiency [ 98 ] and intravenous corticosteroid treatment was started followed by oral therapy with subsequent symptom resolution. In these two cases, the presence of underlying autoimmune disease may predispose COVID-19 patients to develop coagulation disorders and disseminated intravascular coagulation (DIC) and thrombosis with subsequent hemorrhage in the most vascularized organs [ 99 ].…”

Section: Resultsmentioning

confidence: 93%

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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“…A direct negative effect on pituitary corticotroph cells was described during previous SARS outbreak in 2002-2003: according to both basal serum cortisol and dynamic test (especially the low-dose short synacthen test), up to 40% of the cohort was found with an insufficient HPA axis [18]. Recently, a primary adrenal injury consistent with bilateral adrenal haemorrhage has been reported in a patient with Covid-19 infection [19].…”

Section: Risk Of Adrenal Insufficiency In Patients With Covid-19mentioning

confidence: 97%

What we have to know about corticosteroids use during Sars-Cov-2 infection

Ferraú

Ceccato

Cannavò

et al. 2020

J Endocrinol Invest

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Purpose Glucocorticoids (GCs), alone or associated to other drugs, were widely used in the management of patients affected by severe acute respiratory syndrome caused by SARS-CoV-2 infection, during the recent COVID-19 outbreak. This review summarizes the available data on HPA axis impairment in GC-treated SARS-CoV-2 patients, focusing on the risk of adrenal insufficiency and on potential drug interactions during concomitant treatments. Methods Literature on the impact of GCs therapy on HPA axis and on the consequences of coadministration of GCs and other drugs in SARS-CoV-2 patients has been reviewed. Results GC treatment can cause symptoms of hypercortisolism, especially in patients with individual hypersensibility, or hypoadrenalism after drug withdrawal, due to hypothalamic-pituitary-adrenal (HPA) axis suppression, with consequences in terms of increased morbidity and mortality risk. On the other hand, in SARS-CoV-2-infected patient's cortisol secretion could be insufficient also due to critical illness-related corticosteroid insufficiency (CIRCI). In addition, in this clinical context, the co-administration of antiretroviral drugs and corticosteroids may trigger drug-drug interaction and enhance the exposure to the latter ones, metabolized through the CYP450 CYP3A pathway, severely impacting on HPA axis. Conclusion Physicians involved in the management of patients affected by COVID-19 should be aware of the need of an appropriate GC dose tapering, and of potential interaction of GCs with antiviral therapy and drugs used to treat associated co-morbidities.

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Case Report: COVID-19 with Bilateral Adrenal Hemorrhage

Cited by 37 publications

References 8 publications

Massive intraperitoneal hemorrhage in patients with COVID-19: a case series

Massive intraperitoneal hemorrhage in patients with COVID-19: a case series

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

What we have to know about corticosteroids use during Sars-Cov-2 infection

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