Bilateral adrenal hemorrhage in Coronavirus disease 2019 patient: A case report

Meir Frankel, Itamar Feldman, Michal Levine, Yigal Frank, Naama R Bogot, Ofer Benjaminov, Ramzi Kurd, Gabriel S Breuer, Gabriel Munter
2020 Journal of Clinical Endocrinology and Metabolism  
Context Bilateral adrenal hemorrhage is a rare condition with potentially life-threatening consequences 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 decription A 66-years-old woman presented with acute COVID-19 infection and primary adrenal insufficiency due to bilateral adrenal hemorrhage (BAH).
more » ... e had also a renal vein thrombosis. Her past medical history revealed primary antiphospholipid syndrome (APLS). 4 weeks after discharge she had no signs of COVID-19 infection and her PCR 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 to consider performing early adrenal axis testing for COVID-19 patients with clinical suspicion of adrenal insufficiency.
doi:10.1210/clinem/dgaa487 pmid:32738040 fatcat:kp2dgjrrnfae3jtnom4qx66nle