Bilateral Adrenal Hemorrhage in Coronavirus Disease 2019 Patient: A Case Report

Abstract Context Bilateral adrenal hemorrhage is a rare condition with potentially life-threatening consequences such as acute adrenal insufficiency. Early adrenal axis testing, as well as directed imaging, is crucial for immediate diagnosis and treatment. Coronavirus disease 2019 (COVID-19) has bee...

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Published in:	The Journal of Clinical Endocrinology & Metabolism 2020-12, Vol.105 (12), p.1-3749
Main Authors:	Frankel, Meir, Feldman, Itamar, Levine, Michal, Frank, Yigal, Bogot, Naama R, Benjaminov, Ofer, Kurd, Ramzi, Breuer, Gabriel S, Munter, Gabriel
Format:	Article
Language:	eng
Subjects:	Adrenal Gland Diseases - etiology Adrenal Gland Diseases - pathology Adrenal glands Aged Antiphospholipid syndrome Betacoronavirus - isolation & purification Care and treatment Case studies Clinical Coronavirus Infections - complications Coronavirus Infections - virology Coronaviruses COVID-19 Diagnosis Female Fludrocortisone Glucocorticoids Health aspects Hemorrhage Hemorrhage - etiology Hemorrhage - pathology Humans Infections Pandemics Patients Pneumonia, Viral - complications Pneumonia, Viral - virology Polymerase chain reaction Prognosis SARS-CoV-2 Thromboembolism Thrombosis Thrombosis - etiology Thrombosis - pathology
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Summary:	Abstract Context Bilateral adrenal hemorrhage is a rare condition with potentially life-threatening consequences such as acute adrenal insufficiency. Early adrenal axis testing, as well as directed imaging, is crucial for immediate diagnosis and treatment. Coronavirus disease 2019 (COVID-19) has been associated with coagulopathy and thromboembolic events. Case description A 66-year-old woman presented with acute COVID-19 infection and primary adrenal insufficiency due to bilateral adrenal hemorrhage (BAH). She also had a renal vein thrombosis. Her past medical history revealed primary antiphospholipid syndrome (APLS). Four weeks after discharge she had no signs of COVID-19 infection and her polymerase chain reaction test for COVID-19 was negative, but she still needed glucocorticoid and mineralocorticoid replacement therapy. The combination of APLS and COVID-19 was probably responsible of the adrenal event as a “two-hit” mechanism. Conclusions COVID-19 infection is associated with coagulopathy and thromboembolic events, including BAH. Adrenal insufficiency is life threatening; therefore, we suggest that early adrenal axis testing for COVID-19 patients with clinical suspicion of adrenal insufficiency should be carried out.
ISSN:	0021-972X 1945-7197