Cureus . Secondary Adrenal Insufficiency After COVID-19 Diagnosed by Insulin Tolerance Test and Corticotropin-Releasing Hormone Test

[tetano]

Cureus


. 2022 Mar 10;14(3):e23021.
doi: 10.7759/cureus.23021. eCollection 2022 Mar.
Secondary Adrenal Insufficiency After COVID-19 Diagnosed by Insulin Tolerance Test and Corticotropin-Releasing Hormone Test


Kenya Hamazaki ¹ , Tomoko Nishigaki ² , Naoki Kuramoto ² , Koji Oh ¹ , Hiroki Konishi ¹



Affiliations

• PMID: 35281581
• PMCID: PMC8908067
• DOI: 10.7759/cureus.23021

Abstract

Coronavirus disease 2019 (COVID-19) can affect multiple organs and systems, including the endocrine system. Its symptoms can last for months, resulting in post-COVID-19 conditions, among others. A small number of patients have central adrenal insufficiency (CAI) months after recovery from COVID-19; nevertheless, its pathogenesis has not been fully elucidated. The insulin tolerance test (ITT) is a gold standard test assessing the hypothalamic-pituitary-adrenal axis, and the corticotropin-releasing hormone (CRH) test is useful for differentiating CAI into secondary (pituitary) and tertiary (hypothalamic) adrenal insufficiency. We present a case of new-onset CAI in a young female patient who had no medical history other than COVID-19. Adrenocorticotropin hormone and cortisol responded poorly to both insulin-induced hypoglycemia and CRH administration. These findings suggest that the pituitary gland may be the primary site of hypothalamic-pituitary-adrenal dysfunction, although magnetic resonance imaging of the pituitary gland was unremarkable. To our knowledge, this is possibly the first and only case report of new-onset secondary adrenal insufficiency after recovery from COVID-19 in which the ITT and the CRH test were performed and highly suggestive for the pathogenesis of not only post-COVID-19 CAI but also post-COVID-19 conditions.

Keywords: adrenocorticotropic hormone deficiency; central adrenal insufficiency; coronavirus disease 2019; corticotropin-releasing hormone test; hypothalamic–pituitary–adrenal axis; insulin tolerance test; long covid; post-covid-19 conditions; secondary adrenal insufficiency; severe acute respiratory syndrome coronavirus 2.