tetano
Editor, Senior Moderator
AACE Clin Case Rep
. 2023 May-Jun;9(3):71-73.
doi: 10.1016/j.aace.2023.02.005. Epub 2023 Feb 24. A Delayed Presentation of Bilateral Adrenal Hemorrhage Secondary to COVID-19
Stephanie Zilberman[SUP] 1 [/SUP], Laura Winner[SUP] 1 [/SUP], Judith Giunta[SUP] 2 [/SUP], Daniel C Rafii[SUP] 2 3 [/SUP]
Affiliations
Background/objective: Bilateral adrenal hemorrhage is a rare cause of adrenal insufficiency. Cases have been reported of acute adrenal crisis with bilateral adrenal hemorrhage during acute coronavirus disease of 2019 (COVID-19). Our objective was to report a delayed presentation of acute adrenal crisis with bilateral adrenal hemorrhage 2 months after COVID-19.
Case report: An 89-year-old man who was hospitalized for COVID-19 pneumonia 2 months prior presented with lethargy. He was disorientated and hypotensive to 70/50 mm Hg without improvement with intravenous fluids. According to his family, since his previous hospitalization for COVID-19, his mental status had continued to deteriorate, and he was no longer able to perform activities of daily living. A computed tomography scan of the abdomen revealed bilateral heterogeneous enlargement of the adrenal glands. Laboratory values were significant for an am cortisol level of 8.42 mcg/dL, a sodium level of 134 mEq/L, and a bicarbonate level of 17 mEq/L. He was treated intravenously with hydrocortisone 100 mg and showed rapid improvement.
Discussion: It has been shown that COVID-19 disease may cause an increased risk of bleeding or thromboembolism. The exact frequency of bilateral adrenal hemorrhage secondary to COVID-19 is unknown. Although there are a handful of cases reported, there are none to our knowledge with a delayed presentation, as exhibited in our patient.
Conclusion: The patient's presentation was consistent with acute adrenal crisis due to bilateral adrenal hemorrhage from prior COVID-19 disease. We aimed to highlight the importance of clinicians being aware of adrenal hemorrhage and adrenal insufficiency as a possible delayed consequence in patients with a history of COVID-19.
Keywords: COVID-19; adrenal; hemorrhage.
. 2023 May-Jun;9(3):71-73.
doi: 10.1016/j.aace.2023.02.005. Epub 2023 Feb 24. A Delayed Presentation of Bilateral Adrenal Hemorrhage Secondary to COVID-19
Stephanie Zilberman[SUP] 1 [/SUP], Laura Winner[SUP] 1 [/SUP], Judith Giunta[SUP] 2 [/SUP], Daniel C Rafii[SUP] 2 3 [/SUP]
Affiliations
- PMID: 37206647
- PMCID: PMC9957334
- DOI: 10.1016/j.aace.2023.02.005
Background/objective: Bilateral adrenal hemorrhage is a rare cause of adrenal insufficiency. Cases have been reported of acute adrenal crisis with bilateral adrenal hemorrhage during acute coronavirus disease of 2019 (COVID-19). Our objective was to report a delayed presentation of acute adrenal crisis with bilateral adrenal hemorrhage 2 months after COVID-19.
Case report: An 89-year-old man who was hospitalized for COVID-19 pneumonia 2 months prior presented with lethargy. He was disorientated and hypotensive to 70/50 mm Hg without improvement with intravenous fluids. According to his family, since his previous hospitalization for COVID-19, his mental status had continued to deteriorate, and he was no longer able to perform activities of daily living. A computed tomography scan of the abdomen revealed bilateral heterogeneous enlargement of the adrenal glands. Laboratory values were significant for an am cortisol level of 8.42 mcg/dL, a sodium level of 134 mEq/L, and a bicarbonate level of 17 mEq/L. He was treated intravenously with hydrocortisone 100 mg and showed rapid improvement.
Discussion: It has been shown that COVID-19 disease may cause an increased risk of bleeding or thromboembolism. The exact frequency of bilateral adrenal hemorrhage secondary to COVID-19 is unknown. Although there are a handful of cases reported, there are none to our knowledge with a delayed presentation, as exhibited in our patient.
Conclusion: The patient's presentation was consistent with acute adrenal crisis due to bilateral adrenal hemorrhage from prior COVID-19 disease. We aimed to highlight the importance of clinicians being aware of adrenal hemorrhage and adrenal insufficiency as a possible delayed consequence in patients with a history of COVID-19.
Keywords: COVID-19; adrenal; hemorrhage.