New onset adrenal insufficiency in a patient with COVID-19

Abstract

SARS-CoV-2 is the cause of COVID-19. Since the outbreak and rapid spread of COVID-19, it has been apparent that the disease is having multi-organ system involvement. Still its effect in the endocrine system is not fully clear and data on cortisol dynamics in patients with COVID-19 are not yet available. SARS-CoV-2 can knock down the host’s cortisol stress response. Here we present a case of a 51-year-old man vomiting for 10 days after having confirmed COVID-19 infection. He had hypotension and significant hyponatraemia. Work-up was done including adrenocorticotropic hormone stimulation test. He was diagnosed as suffering from adrenal insufficiency and started on steroids with subsequent improvement in both blood pressure and sodium level. COVID-19 can cause adrenal insufficiency. Clinicians must be vigilant about the possibility of an underlying relative cortisol deficiency in patients with COVID-19.

COVID-19 and the Endocrine System: A Comprehensive Review on the Theme

“…For instance, autoptic studies in SARS deceased patients had shown degeneration and necrosis of adrenal cortical cells, and SARS-CoV was identified in the adrenal glands, possibly confirming a direct cytopathic effect [209]. As ACE2 is widely expressed at adrenal levels, it is believed that SARS-CoV-2 may lead to similar detrimental consequences as described for other coronaviruses [209], even if a causal relationship between new-onset PAI and SARS-CoV-2 remains to be confirmed [210,211]. Microscopic examination of the adrenal glands from COVID-19 deceased patients showed acute fibrinoid necrosis of small vessels, mainly arterioles, in adrenal parenchyma, capsule, and periadrenal adipose tissue with subendothelial vacuolization and apoptotic debris without significant signs of inflammation, parenchymal infarctions, or thrombosis [212].…”

Adrenal Insufficiency in Coronavirus Disease 2019 (COVID-19)-Infected Patients without Preexisting Adrenal Diseases: A Systematic Literature Review

“…After removing duplicates and implementing inclusion and exclusion criteria, 10 articles (cross-sectional studies: 3, case reports: 7) were enrolled for the current review ( Figure 1 ). AI was defined based on laboratory data, computed tomography (CT) results, or a combination of both methods [ 17 , 18 , 24 , 25 ]. A summary of included studies based on their designs is provided in Tables 1 and 2 .…”

“…Evaluation of AI was done through CT findings, laboratory profiles, or both in 2 [ 24 , 28 ], 3 [ 17 , 18 , 31 ], and 2 [ 29 , 30 ] patients, respectively. Only one patient died [ 28 ], and all 6 others were discharged in stable condition with appropriate medical treatment [ 17 , 18 , 24 , 29 – 31 ]. 2 patients were followed up after hospital discharge with normal status [ 24 , 29 ].…”

“…2 patients were followed up after hospital discharge with normal status [ 24 , 29 ]. However, two other subjects failed to attend follow-up visits [ 17 , 31 ]. The follow-up data of two patients were not available [ 18 , 30 ].…”

“…The involvement of these organs might lead to a catastrophic outcome. Till now, some case reports have been published in patients who experienced adrenal insufficiency (AI) in the context of COVID-19, but a thorough investigation in literature seems required [ 17 , 18 ].…”