Endocrine Abstracts

Introduction: There are emerging reports showing the relationship between human immunodeficiency virus (HIV), Covid-19 and adrenal insufficiency. This was attributed to thrombotic events and necrosis, leading to hypoadrenalism. The HIV virus can also lead to Addison”s disease due to destruction of adrenal gland. Prevalence of adrenal infarction with COVID-19 was found to be 23% and 88% this was shown to be affecting both adrenal glands.

Case report: A 46-year female with HIV presented with fever, hyponatraemia of 129 mmol/l and was subsequently diagnosed with Pneumonia. She recovered well with antibiotics. Four months prior to her presentation, she tested positive for COVID-19 and experienced gradual weight loss of 15 kg with tiredness all the time. Further investigations for hyponatraemia showed low cortisol level of 21 nmol/l and repeat of 29 nmol/l with ACTH below 3ng/l (7.2-63.3ng/l) and screening for adrenal antibodies was negative for adrenocortical antibodies. Tuberculosis was excluded using Elispot, sputum and BAL culture and cytology. Magnetic resonance imaging of the pituitary, autoimmune, hormonal, and biochemical screenings were all normal. Importantly, the pituitary production of all other hormones was in the normal range. In the view of negative findings, she was deemed to have isolated ACTH deficiency with resulting in Addison”s disease associated with COVID-19. She was started on intravenous hydrocortisone and in few days her sodium improved to 143 mmol/l which was later converted to hydrocortisone tablets. Since taking Hydrocortisone, she has stopped vomiting and her weight is steadily increasing. To our knowledge, there are potentially increased risk of Addison”s disease in individuals living with HIV through isolated ACTH deficiency following COVID-19 infections.

Conclusion: This case demonstrates association of COVID-19 with Addison”s disease in HIV. Previous cases and studies showed adrenal insufficiency associated HIV and COVID-19 likely linked to destruction of adrenal glands. There is possibility of direct insult to adrenal glands by Coronavirus by causing haemorrhage, necrosis or venous thromboembolism which can lead to consequence of hypoadrenalism. Such thrombotic events in adrenal glands can lead to impaired function of pituitary adrenal axis. Our case shows that COVID-19 in individuals living with HIV may also decrease the pituitary production of ACTH. Therefore, further research is needed to understand why the ACTH pituitary production is more vulnerable to the impact of COVID-19 in comparison with other hormones produced by the pituitary gland.