A case of unilateral post-COVID-19 adrenal haemorrhage and follow-up during pregnancies
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
The spectrum of endocrine-related complications of COVID-19 infection is expanding; one of the most concerning of which is adrenal haemorrhage due to the risk of catastrophic adrenal crisis. In this study, we present a case that highlights the challenging management of a large, indeterminate unilateral adrenal mass during pregnancy and draws attention to a rare yet probably underestimated complication of COVID-19. During hospitalization for severe COVID-19 pneumonia, a 26-year-old woman was incidentally found to have a 12.5 cm heterogeneous left adrenal mass. Soon after the discovery, she became pregnant and upon referral, she was in the seventh week of gestation, without clinical or biochemical features of hormonal excess. The uncertainty of the diagnosis and the risks of malignancy and surgical intervention were discussed with the patient, and a period of radiological surveillance was agreed upon. An MRI scan performed 3 months later showed a size reduction of the adrenal lesion to 7.9 cm, which was against malignancy. A Doppler ultrasound showed a non-vascular, well-defined round lesion consistent with an adrenal haematoma, likely a complication of the recent COVID-19 infection. The multidisciplinary team recommended further radiological follow-up. The patient then spontaneously had miscarriage at 12 weeks gestation. Subsequent radiological surveillance showed a further size reduction of the adrenal lesion to 5.5 cm. The patient conceived again during follow-up, and the repeated Doppler ultrasound showed stable appearances of the adrenal mass, and thus, it was agreed to continue radiological monitoring after delivery. The pregnancy was uneventful, and the patient delivered a healthy baby. An MRI scan performed after delivery showed a stable but persistent lesion consistent with a likely underlying adrenal lesion.
Date Issued
2022-12-01
Date Acceptance
2022-12-06
Citation
Endocrinology, Diabetes & Metabolism Case Reports, 2022, 2022 (1)
ISSN
2052-0573
Publisher
Bioscientifica
Journal / Book Title
Endocrinology, Diabetes & Metabolism Case Reports
Volume
2022
Issue
1
Copyright Statement
© 2022 The authors. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/36541667
PII: 22-0337
Subjects
2022
Adrenal
ADRENOCORTICAL CARCINOMA
Adult
COLLABORATION
December
Endocrinology
Endocrinology & Metabolism
EUROPEAN-SOCIETY
Female
Gynaecological Endocrinology
INCIDENTALOMAS
Infectious diseases
Life Sciences & Biomedicine
MANAGEMENT
NETWORK
Oncology
Science & Technology
unexpected symptoms or presentations of a disease
Unique
United Kingdom
URINE STEROID METABOLOMICS
White
Publication Status
Published
Coverage Spatial
England
Article Number
220337
Date Publish Online
2022-12-21