Majety Priyanka, Erlikh Natanie, Hou Runhua
Endocrinology, Diabetes, and Metabolism, Virginia Commonwealth University, Richmond, USA.
Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
Cureus. 2023 Jun 30;15(6):e41210. doi: 10.7759/cureus.41210. eCollection 2023 Jun.
Coronavirus disease 2019 (COVID-19) has been associated with thrombotic and endocrine complications, including adrenal insufficiency in the setting of adrenal hemorrhage. We present a patient diagnosed with antiphospholipid syndrome (APLS) in the setting of COVID-19 infection resulting in bilateral adrenal hemorrhage, subsequently leading to adrenal insufficiency. Acute adrenal hemorrhage is an underrecognized cause of decompensation, multisystem failure, and death in severe illness. Reports of adrenal insufficiency in the setting of COVID-19 infection revealed microscopic infarction, which can increase the risk of hemorrhage. Other mechanisms include severe hyperinflammatory response and cytokine storm leading to endothelial dysfunction, vascular injury, adrenal parenchymal damage, and hemorrhage. COVID-19 infection can be associated with coagulopathy and thromboembolic events and can lead to adrenal hemorrhage. Adrenal insufficiency is life-threatening and needs to be recognized promptly. There can be a latent phase between hemorrhagic events and adrenal failure; hence, close monitoring and timely intervention are important.
2019冠状病毒病（COVID-19）与血栓形成和内分泌并发症有关，包括肾上腺出血导致的肾上腺功能不全。我们报告一例在COVID-19感染背景下被诊断为抗磷脂综合征（APLS）的患者，该感染导致双侧肾上腺出血，随后导致肾上腺功能不全。急性肾上腺出血是重症患者失代偿、多系统衰竭和死亡的一个未被充分认识的原因。COVID-19感染背景下肾上腺功能不全的报告显示存在微观梗死，这会增加出血风险。其他机制包括严重的高炎症反应和细胞因子风暴，导致内皮功能障碍、血管损伤、肾上腺实质损伤和出血。COVID-19感染可与凝血病和血栓栓塞事件相关，并可导致肾上腺出血。肾上腺功能不全危及生命，需要及时识别。出血事件和肾上腺衰竭之间可能存在潜伏期；因此，密切监测和及时干预很重要。
