Adrenal insufficiency in coronavirus disease 2019: a case report
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(2020) 14:134
CASE REPORT
Open Access
Adrenal insufficiency in coronavirus disease 2019: a case report Maryam Heidarpour1†, Mehrbod Vakhshoori2†, Saeed Abbasi3, Davood Shafie4* and Nima Rezaei5,6,7
Abstract Background: Novel coronavirus disease 2019 presents with fever, dry cough, fatigue, and shortness of breath in most cases; however, some rare manifestations in other organs have also been reported so far. Case presentation: Here, the case of a 69-year-old Iranian man with coronavirus disease 2019 is presented who suffered from frequent episodes of vasopressor-resistant hypotension during intensive care unit admission, which was finally attributed to the occurrence of acute adrenal insufficiency. Conclusions: As this is a rare complication, adrenal insufficiency might be easily overlooked. However, early detection of this disease among critically ill patients infected with coronavirus disease 2019 could be lifesaving, especially among those unresponsive to vasopressor agents. Keywords: Adrenal insufficiency, COVID-19, 2019-nCoV, SARS-CoV-2, Case report
Background Since late December 2019 to April 2020, more than 2.8 million cases of novel coronavirus disease 2019 (COVID-19) have been reported around the world. COVID-19 has a broad spectrum of severity, ranging from asymptomatic to respiratory distress that requires mechanical ventilation [1–3]. However, some patients may develop sepsis, which can happen very quickly and lead to tissue damage, organ failure, and death [2]. In these patients, resistant hypotension might even lead to death in a short time. On the other hand, in the complex setting of critical illness, adrenal insufficiency is easily overlooked as a cause of vasopressor-resistance hypotension [4]. Therefore, it can be assumed that an endocrinological basis could account for some of the extrapulmonary manifestations of COVID-19 infection. Due to the novelty of this pathogen, other presentations * Correspondence: [email protected] † Maryam Heidarpour and Mehrbod Vakhshoori contributed equally to this work. 4 Cardiology/Heart Failure and Transplantation, Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Full list of author information is available at the end of the article
of this infection would not be unexpected. In this report, we present the case of a 69-year-old man with COVID19, who experienced an acute crisis of adrenal insufficiency during hospitalization.
Case presentation On 27 February 2020, a 69-year-old Iranian man was referred to our hospital, complaining of fever, dyspnea, and dry cough. He had a history of hypertension, which was well controlled with antihypertensive agents. His symptoms started 5 days before admission. Initial vital signs included a blood pressure of 130/80 mmHg, heart rate of 109 beats per minute (bpm), respiratory rate of 28 per minute, O2 saturation of 88% on room air, and temperature of 38.3 °C. Laboratory data are shown in Table 1. Due to his respiratory problems, he underwent a
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