Endocrine Abstracts

Case history: A 62-year-old lady with no significant past medical history presented early February 2021 with a week history of epigastric pain, tiredness and poor oral intake, 5 days following her first dose of AstraZeneca Covid-19 vaccine. She was cardiovascularly stable but generalised abdominal tenderness was noted. There was no history of hypertension, hypokalaemia or symptoms consistent with phaeochromocytoma.

Investigations: Admission bloods revealed significant thrombocytopenia. CT scan revealed hepatic vein thrombosis and bilateral adrenal haemorrhage with no evidence of underlying adrenal masses. Adrenal insufficiency was confirmed on short Synacthenâ test. An underlying autoimmune process was excluded with normal lupus and vasculitis screens. Metastatic or tuberculous infiltration were excluded including CT-PET scan.

Treatment: The patient was managed by multi-disciplinary approach involving haematologist, endocrinologist and gastroenterologist and commenced on heparin and intravenous hydrocortisone. She was discharged on direct oral anticoagulant and oral steroids. Following case reports of vaccine induced thrombosis and thrombocytopaenia (VIIT) associated with Covid-19 vaccine, the temporal relationship between this patient’s onset of symptoms and her first dose of AstraZeneca vaccine was noted by her haematologist. The case was reported to the MHRA.

Conclusion: Bilateral adrenal haemorrhage associated with thrombosis in this case was likely due to VIIT. Unusual sequelae of Covid-19 vaccine are increasingly being recognised, with VIIT particularly associated with AstraZenca Covid-19 vaccine, typically presenting 5 to 28 days after first dose. Awareness of such complications is of paramount importance as the vaccination rollout continues globally. To our knowledge, this is this first case of VIIT due to Covid-19 vaccine causing bilateral adrenal haemorrhage resulting in adrenal failure. Endocrine follow up of this case will determine if the adrenal insufficiency is temporary or permanent.