scholarly journals Primary adrenal insufficiency due to bilateral adrenal infarction in COVID-19: a case report

2021 ◽  
Author(s):  
Iza F R Machado ◽  
Isabel Q Menezes ◽  
Sabrina R Figueiredo ◽  
Fernando Morbeck Almeida Coelho ◽  
Debora R B Terrabuio ◽  
...  
Keyword(s):  
Case Report ◽  
Adrenal Insufficiency ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Case Reports ◽  
Serum Cortisol ◽  
Primary Adrenal Insufficiency ◽  
Acute Adrenal Insufficiency ◽  
Adrenal Infarction ◽  
New Onset

Abstract 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, skin hyperpigmentation after COVID-19 infection. The patient had hyponatremia, serum cortisol <1.0 ug/dL, 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 Among 115 articles, we identified nine 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 five cases, but ACTH levels were measured in only three cases (high in one case and normal/low in other two cases). Bilateral adrenal non- or hemorrhagic infarction was identified in five reports (two had adrenal insufficiency, two had normal cortisol levels and one 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. Conclusions 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.

POSACONAZOLE INDUCED PSEUDOHYPERALDOSTERONISM WITH CONCURRENT ACUTE PRIMARY ADRENAL INSUFFICIENCY-A CASE REPORT

2021 ◽  
pp. 41-42
Author(s):  
Priyadharshini Swaminathan ◽  
Bharath Kumar ◽  
Indumathi K ◽  
Theranirajan Theranirajan
Keyword(s):  
Case Report ◽  
Pulmonary Edema ◽  
Adrenal Insufficiency ◽  
Similar Case ◽  
Case Reports ◽  
Acute Pulmonary Edema ◽  
Potential Mechanism ◽  
Primary Adrenal Insufficiency ◽  
Hypertensive Urgency ◽  
New Onset

In this covid 19 pandemic,there were increased incidence of Mucormycosis and thereby increase in usage of antifungals especially oral posaconazole which is more recently available in tablet form.There are already enough case reports of the incidence of new onset hypertension and hypokalemia with supressed renin and aldosterone which is termed as “Posaconazole induced pseudohyperaldosteronism”.We describe here about a similar case that presented with hypertensive urgency as Acute pulmonary edema with an associated primary adrenal insufciency.The potential mechanism include inhibition of 11 β HSD which degrades cortisol to cortisone,thereby increasing the levels of cortisol that stimulates Mineralocorticoid receptor.Also there is inhibition of steroidogenesis at the level of adrenal which in our patient presented with features of Acute adrenal insufciency.

An unusual presentation of primary adrenal insufficiency with new onset type 1 diabetes: case report and review of the literature

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shelby Graf ◽  
Rachel Stork Poeppelman ◽  
Jennifer McVean ◽  
Arpana Rayannavar ◽  
Muna Sunni
Keyword(s):  
Type 1 Diabetes ◽  
Adrenal Insufficiency ◽  
Diabetic Ketoacidosis ◽  
Serum Cortisol ◽  
Unusual Presentation ◽  
Primary Adrenal Insufficiency ◽  
Onset Type ◽  
Autoimmune Conditions ◽  
New Onset

Abstract Objectives To describe an atypical presentation of primary adrenal insufficiency in conjunction with new onset type 1 diabetes. Case presentation Here, we describe a case of new-onset type 1 diabetes (T1D) presenting simultaneously with an unusual presentation of primary adrenal insufficiency in a previously healthy 16-year-old. He was admitted for a typical presentation of diabetic ketoacidosis, but with extreme hyponatremia. An extensive workup revealed a low aldosterone level, appropriate cortisol level, and positive 21-hydroxylase antibodies. While the phenomenon of multiple autoimmune conditions developing in the same patient is well-described, this particular case has several atypical aspects. Our patient’s case highlights the danger of relying on random serum cortisol in the setting of acute illness to rule out adrenal insufficiency. Conclusions Adrenal insufficiency can present as isolated hypoaldosteronism without hypocortisolemia and can manifest as severe hyponatremia in the context of diabetic ketoacidosis. Workup for an unusual presentation of T1D should include a 21-hydroxylase antibody, as well as thyroid and celiac disease studies.

scholarly journals Adrenal Tuberculosis Leading to Acute Adrenal Insufficiency

2021 ◽  
Vol 11 (6) ◽  
pp. 148-151
Author(s):  
Nitu Sharma ◽  
Yashika Bhatia
Keyword(s):  
Case Report ◽  
Infectious Diseases ◽  
Adrenal Insufficiency ◽  
Acute Gastroenteritis ◽  
Primary Infection ◽  
Unusual Case ◽  
Primary Adrenal Insufficiency ◽  
Death Case ◽  
Acute Adrenal Insufficiency ◽  
Adrenal Deficiency

Background: Tuberculosis is the ‘world’s largest killer’ amongst infectious diseases overtaking HIV in 2014. Tuberculosis can affect the kidneys and adrenals as either primary infection or secondary dissemination from other organs. Tuberculosis in adrenals manifests in the acute phase leading to primary adrenal insufficiency, which is generally catastrophic leading to death. Case Report: We present an unusual case of a 42 years’ old man, presented & managed as a case of acute gastroenteritis. Patient had a fulminant course and succumbed to his illness. Autopsy revealed Bilateral Adrenal Tuberculosis. Conclusion: Adrenal tuberculosis has the potential of causing acute adrenal deficiency leading to Addisonian crisis and consequent mortality. Key words: Adrenal tuberculosis, Addisonian crisis, acute adrenal insufficiency.

scholarly journals Primary Adrenal Insufficiency Due to Bilateral Adrenal Hemorrhage-Adrenal Infarction in the Antiphospholipid Syndrome: Long-Term Outcome of 16 Patients

2013 ◽  
Vol 98 (8) ◽  
pp. 3179-3189 ◽  
Author(s):  
Isolde Ramon ◽  
Alexis Mathian ◽  
Anne Bachelot ◽  
Baptiste Hervier ◽  
Julien Haroche ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Acute Phase ◽  
Antiphospholipid Syndrome ◽  
Adrenal Hemorrhage ◽  
Primary Adrenal Insufficiency ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Bilateral Adrenal Hemorrhage ◽  
Adrenal Infarction

Context: Primary adrenal insufficiency due to bilateral adrenal hemorrhage-adrenal infarction is a rare and life-threatening manifestation of the antiphospholipid syndrome (APLS). Data on the long-term outcome are scarce. Objective: The aims of the present study were to analyze the long-term outcome related to APLS per se and to characterize the course of adrenal involvement. Design: We conducted a retrospective study of patients with bilateral adrenal hemorrhage-adrenal infarction secondary to APLS seen in the Department of Internal Medicine of Pitié-Salpêtrière Hospital in Paris (France) between January 1990 and July 2010. Results: Three patients died during the acute phase related to APLS manifestations. Sixteen patients (7 males; 9 females) were followed up during a median period of 3.5 years (range 0.3–28.1 years). Three episodes of recurrent thrombosis were noted. One patient died from cerebral hemorrhage 3 months after the onset of adrenal insufficiency. Repeated Synacthen tests showed complete absence of response in 8 of the 10 patients assessed; cortisol and aldosterone increased appropriately in one patient and to some extent in another one. Dehydroepiandrosterone levels and 24-hour urinary epinephrine levels remained abnormally low in all evaluated patients. Adrenal imaging performed more than 1 year after the initial event revealed completely atrophic glands in 9 of 11 patients. Conclusions: This particular subset of APLS patients who survive the acute phase has a rather favorable long-term outcome. Although adrenal dysfunction is generally irreversible, adrenocortical function may, at least partially, recover in rare cases. In this view, measurement of early morning cortisol during follow-up is indicated to detect these patients.

A case of cancer-associated hyponatraemia: primary adrenal insufficiency secondary to nivolumab

2021 ◽  
Vol 21 ◽  
Author(s):  
Silvia Galliazzo ◽  
Filippo Morando ◽  
Paola Sartorato ◽  
Michela Bortolin ◽  
Ernesto De Menis
Keyword(s):  
Adverse Events ◽  
Adrenal Insufficiency ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Serum Cortisol ◽  
Sodium Concentration ◽  
Primary Hypothyroidism ◽  
Biochemical Tests ◽  
Primary Adrenal Insufficiency ◽  
Replacement Treatment

Background: Immunotherapy with immune checkpoint inhibitors is a new frontier for cancer treatment. On the safety profile, this drug class is associated with a new spectrum of side effects, the so-called immune-related adverse events that can potentially affect any organs, mainly endocrine glands. Scant data are available to inform the appropriate strategy of their management and treatment. Case Presentation: A 74-years man with squamous non-small cell lung cancer on nivolumab was hospitalized for fatigue, nausea, vomiting and severe hyponatremia. Biochemical tests were significant for hypotonic hyponatremia with a high urine sodium concentration. Endocrine tests showed overt primary hypothyroidism and low serum cortisol and aldosterone levels associated with an elevated circulating level of adrenocorticotrophic hormone. Adrenal antibody screening and the search of adrenal lesion on CT abdomen were negative. Thus, a nivolumab-induced primary adrenal insufficiency was diagnosed. Nivolumab withdrawal and replacement treatment with glucocorticoid and mineralocorticoid allowed clinical and biochemical recovery. Conclusion: Physicians need to be aware of potential immune-related adverse events in all patients treated with an immune checkpoint inhibitor. Their timely recognition is essential to carry out the proper treatment.

scholarly journals Primary Adrenal Insufficiency due to Multidrug-Resistant Tuberculosis: A Case Report

2017 ◽  
Vol 7 (3) ◽  
pp. 235-237
Author(s):  
Sultana Marufa Shefin ◽  
Kazi Nazmul Hossain ◽  
Jamal Uddin Ahmed ◽  
Mohammad Mostafizur Rahman
Keyword(s):  
Adrenal Gland ◽  
Adrenal Insufficiency ◽  
Adrenal Glands ◽  
Serum Cortisol ◽  
Needle Aspiration ◽  
Multidrug Resistant ◽  
Primary Adrenal Insufficiency ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Tuberculosis (TB) is a common infectious disease in developing countries like Bangladesh. Drug-resistant tuberculosis (DR-TB) poses a significant threat to the population. A relatively uncommon site of involvement of TB is adrenal gland, which is an important cause of chronic adrenal insufficiency. Here we present a case of a 40-year-old male with multidrug-resistant tuberculosis (MDR-TB) involving the adrenal glands. He was previously diagnosed as a case of disseminated TB involving lungs, right knee joint and lumbar spine and received anti-TB chemotherapy for several occasions and in different categories in last 12 years before this presentation. He presented with 4-month history of vomiting, diarrhea, generalized weakness, generalized pigmentation and postural hypotension. Investigations revealed hyponatremia with hyperkalemia. Adrenal insufficiency was suspected and serum cortisol was found to be low and serum adreno corticotropic hormone (ACTH) was high. On imaging there was bilateral adrenal enlargement. Fine needle aspiration cytology (FNAC) was done from adrenal gland which revealed granulomatous lesion suggestive of TB. Gene Xpert and culture-sensitivity of aspirated material for Mycobacterium tuberculosis revealed MDR-TB. Patient was finally diagnosed as a case of primary adrenal insufficiency due to MDR-TB of the adrenal glands and was treated with regime for MDR-TB for 20 months.Birdem Med J 2017; 7(3): 235-237

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