Primary Adrenal Insufficiency Due to Bilateral Adrenal Infarction in COVID-19

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art_MACHADO_Primary_Adrenal_Insufficiency_Due_to_Bilateral_Adrenal_Infarction_2022.PDF (18.41 MB)
Citações na Scopus
19
Tipo de produção
article
Data de publicação
2022
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
ENDOCRINE SOC
Autores
Citação
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, v.107, n.1, p.E394-E400, 2022
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Context: Coronavirus disease 2019 (COVID-19) is a proinflammatory and prothrombotic condition, but its impact on adrenal function has not been adequately evaluated. Case report: A 46-year-old woman presented with abdominal pain, hypotension, and skin hyperpigmentation after COVID-19 infection. The patient had hyponatremia, serum cortisol <1.0 mu g/dL, adrenocorticotropin (ACTH) of 807 pg/mL, and aldosterone <3 ng/dL. Computed tomography (CT) findings of adrenal enlargement with no parenchymal and minimal peripheral capsular enhancement after contrast were consistent with bilateral adrenal infarction. The patient had autoimmune hepatitis and positive antiphospholipid antibodies, but no previous thrombotic events. The patient was treated with intravenous hydrocortisone, followed by oral hydrocortisone and fludrocortisone. Discussion: We identified 9 articles, including case reports, of new-onset adrenal insufficiency and/or adrenal hemorrhage/infarction on CT in COVID-19. Adrenal insufficiency was hormonally diagnosed in 5 cases, but ACTH levels were measured in only 3 cases (high in 1 case and normal/low in other 2 cases). Bilateral adrenal nonhemorrhagic or hemorrhagic infarction was identified in 5 reports (2 had adrenal insufficiency, 2 had normal cortisol levels, and 1 case had no data). Interestingly, the only case with well-characterized new-onset acute primary adrenal insufficiency after COVID-19 had a previous diagnosis of antiphospholipid syndrome. In our case, antiphospholipid syndrome diagnosis was established only after the adrenal infarction triggered by COVID-19. Conclusion: Our findings support the association between bilateral adrenal infarction and antiphospholipid syndrome triggered by COVID-19. Therefore, patients with positive antiphospholipid antibodies should be closely monitored for symptoms or signs of acute adrenal insufficiency during COVID-19.
Palavras-chave
Bilateral adrenal infarction, primary adrenal insufficiency, antiphospholipid syndrome, COVID-19
URI
https://observatorio.fm.usp.br/handle/OPI/44370
Referências
  1. Adem PV, 2005, NEW ENGL J MED, V353, P1245, DOI 10.1056/NEJMoa044194
  2. Al-Samkari H, 2020, BLOOD, V136, P489, DOI 10.1182/blood.2020006520
  3. Alvarez-Troncoso J, 2020, AM J TROP MED HYG, V103, P1156, DOI 10.4269/ajtmh.20-0722
  4. Bancos I, 2015, LANCET DIABETES ENDO, V3, P216, DOI 10.1016/S2213-8587(14)70142-1
  5. Bornstein SR, 2016, J CLIN ENDOCR METAB, V101, P364, DOI 10.1210/jc.2015-1710
  6. Chua Marvin Wei Jie, 2021, AACE Clin Case Rep, V7, P2, DOI 10.1016/j.aace.2020.11.001
  7. Connors JM, 2020, BLOOD, V135, P2033, DOI 10.1182/blood.2020006000
  8. D'Agostino V, 2021, J PERS MED, V11, DOI 10.3390/jpm11040285
  9. Merino JCD, 2020, NEFROLOGIA, V40, P356, DOI 10.1016/j.nefro.2020.05.001
  10. Dolhnikoff M, 2020, J THROMB HAEMOST, V18, P1517, DOI 10.1111/jth.14844
  11. Elkhouly Mohamed M N, 2021, Radiol Case Rep, V16, P1438, DOI 10.1016/j.radcr.2021.03.032
  12. FOX B, 1976, J PATHOL, V119, P65, DOI 10.1002/path.1711190202
  13. Frankel M, 2020, J CLIN ENDOCR METAB, V105, DOI 10.1210/clinem/dgaa487
  14. Hashim M, 2021, BMJ CASE REP, V14, DOI 10.1136/bcr-2020-237690
  15. Kovacs KA, 2001, MEDICINE, V80, P45, DOI 10.1097/00005792-200101000-00005
  16. Kumar R, 2020, BJR CASE REP, V6, DOI 10.1259/bjrcr.20200075
  17. Leyendecker P, 2021, EUR RADIOL, V31, P895, DOI 10.1007/s00330-020-07226-5
  18. Pengo V, 2009, J THROMB HAEMOST, V7, P1737, DOI 10.1111/j.1538-7836.2009.03555.x
  19. Presotto F, 2005, EUR J ENDOCRINOL, V153, P507, DOI 10.1530/eje.1.02002
  20. Sadeghipour P, 2021, JAMA-J AM MED ASSOC, V325, P1620, DOI 10.1001/jama.2021.4152
  21. Santana MF, 2020, AM J TROP MED HYG, V103, P1604, DOI 10.4269/ajtmh.20-0787
  22. Tay MZ, 2020, NAT REV IMMUNOL, V20, P363, DOI 10.1038/s41577-020-0311-8
  23. Trahtemberg U, 2021, ANN RHEUM DIS, V80, P1236, DOI 10.1136/annrheumdis-2021-220206
  24. Whyte CS, 2020, J THROMB HAEMOST, V18, P1548, DOI 10.1111/jth.14872
  25. Zhang Y, 2020, NEW ENGL J MED, V382, DOI 10.1056/NEJMc2007575
  26. Zinserling VA, 2020, HORM METAB RES, V52, P639, DOI 10.1055/a-1191-8094

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - COVID-19
Artigos e Materiais de Revistas Científicas - FM/MGT
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InRad
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