Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective/Background Isolated cases of autoimmune-mediated primary adrenal insufficiency (PAI) after COVID-19 have been reported. However, the association has not been well characterized. To determine the association and clinical characteristics of autoimmune-mediated PAI in patients following COVID-19. Case Report We identified patients with autoimmune-mediated PAI following recent COVID-19 illness from a large database and performed a retrospective chart review to analyze their clinical and biochemical presentation. Prior reported cases were reviewed. Inclusion criteria were biochemical confirmation and clinical features of PAI occurring within 12 months after COVID-19 illness, and evidence of autoimmune etiology. We identified 6 novel autoimmune-mediated PAI cases associated with COVID-19, out of 138,052 cases of positive SARS-CoV-2 PCR. Eleven cases from the literature were added for a total of seventeen patients (58.8% male and 41.2% female). Twelve (70.6%) were <30 years old. Five (29.4%) had a family history of autoimmune conditions. Five (29.4%) had prior autoimmune disease. The median time to PAI diagnosis was 21(9-151) days after SARS-CoV-2 infection. Median serum morning cortisol level was 1.0 (0.5-2.56) μg/dL. Mean serum ACTH was 1212.6+599.8pg/mL, 19.7+11.3 x ULN. Adrenal atrophy was present in 64%; 21-hydroxylase antibodies were positive in 100% (n=16) of patients tested. Discussion This is the largest original case series of autoimmune-mediated PAI associated with COVID-19 to date. Severe illness and/or SARS-CoV-2 viral infection may precipitate autoimmune-mediated primary adrenal insufficiency in susceptible patients. Conclusion Awareness of autoimmune-mediated PAI occurring after COVID-19 is critical for the prevention of adrenal crisis in this context.
Source: AACE Endocrinology and Diabetes
Institutions: Harvard University, Massachusetts General Hospital
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7167836453