COVID-19 Infection in Adrenal Tuberculosis Patients with Adrenal Insufficiency Who Complicated with Adrenal Crisis
Keywords:
adrenal crisis, primary adrenal insufficiency, COVID-19Abstract
Adrenal insufficiency can increase the risk of infection. Respiratory infections play a role in the greater number of mortalities in patients with primary adrenal insufficiency. Severe acute illness elevates the risk of adrenal crisis which can give lethal outcome.A 52-year-old woman came to the emergency unit due to worsening gastrointestinal symptoms for the past 3 days. She had chronic epigastric pain, general weakness, weight loss, and skin hyperpigmentation. She was suspected of primary adrenal insufficiency one year ago, but she had poor compliance. In this current admission, she was suspected to have adrenal crisis and was diagnosed with COVID-19. On the 5th day of inpatient care, her condition was worsening, and she was diagnosed with adrenal crisis, septic shock, and severe COVID-19. Her ACTH level was 78.6 pg/mL (normal range 7.4-64.3 pg/mL) and her morning cortisol level was 1.1 ug/dL (normal range 3.7-19.4). Imaging showed unilateral hypertrophy of the adrenal gland, a positive result of IGRA, and fibrotic of the lung that led to tuberculosis of the adrenal as suspected etiology.Making a diagnosis of adrenal insufficiency is challenging because of its non-specific signs and symptoms. The need for education, equipment (adequate steroid supplies), and empowerment (development of specific guidelines for PAI and COVID-19) were taught to help prevent the adrenal crisis. Further examination is needed to obtain the definitive etiology of adrenal insufficiency in this patient.References
Shepherd LM, Schmidtke KA, Hazlehurst JM, et al. Interventions for the prevention of adrenal crisis in adults with primary adrenal insufficiency: a systematic review. Eur J Endocrinol. 2022;187(1):S1–20.
Suryadevara V, Merugu C, Perumal N, Sahoo J, Kamalanathan S, Naik D. Adrenal crisis in a patient with APS2 due to COVID-19: A case report. J Fam Med Prim Care. 2022;11(5):2228.
Vakhshoori M, Heidarpour M, Bondariyan N, Sadeghpour N, Mousavi Z. Adrenal insufficiency in Coronavirus disease 2019 (COVID-19)-infected patients without preexisting adrenal diseases: A systematic literature review. Int J Endocrinol. 2021;2021.
Wina Dharmesti NW, Saraswati MR, Suastika K, Gotera W, Dwipayana IMP. Challenging diagnosis of addison’s disease presenting with adrenal crisis. Case Rep Endocrinol. 2021;2021.
Betterle C, Presotto F, Furmaniak J. Epidemiology, pathogenesis, and diagnosis of Addison’s disease in adults. J Endocrinol Invest [Internet]. 2019;42(12):1407–33. Available from: https://doi.org/10.1007/s40618-019-01079-6
Anonymous. TB incidence [Internet]. [cited 2023 May 4]. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/tb-disease-burden/2-1-tb-incidence
Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364–89.
Bhattarai P, Allen H, Aggarwal A, Madden D, Dalton K. Unmasking of addison’s disease in COVID-19. SAGE Open Med Case Reports. 2021;9.
Kanczkowski W, Beuschlein F, Bornstein SR. Is there a role for the adrenal glands in long COVID? Nature Reviews Endocrinology. Nature Research. 2022;18:451–2.
Heidarpour M, Vakhshoori M, Abbasi S, Shafie D, Rezaei N. Adrenal insufficiency in coronavirus disease 2019: A case report. J Med Case Rep. 2020;14(1).
Bracci B, De Santis D, Del Gaudio A, et al. Adrenal lesions: A review of imaging. Diagnostics. 2022;12(9).
Haren Noman S van, Visser H, Muller A, Limonard G. Addison’s disease caused by Tuberculosis: Diagnostic and therapeutic difficulties. Eur J Case Reports Intern Med. 2018;1.
Soedarso MA, Nugroho KH, Meira Dewi KA. A case report: Addison disease caused by adrenal tuberculosis. Urol Case Reports. 2018;20:12–4.
Arlt W, Baldeweg SE, Pearce SHS, Simpson HL. Endocrinology in the time of COVID-19: Management of adrenal insufficiency. European Journal of Endocrinology. BioScientifica Ltd. 2020;183:G25–32.
Puttanna A, Cunningham AR, Dainty P. Addison’s disease and its associations. BMJ Case Rep. 2013;1–3.
Downloads
Published
How to Cite
Issue
Section
License
Copyright
The authors who publish in this journal agree to the following requirements:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) before and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. (See The Effect of Open Access)
Privacy Statement
The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.
