Case Report: Primary adrenal insufficiency due to bilateral adrenal infarction and antiphospholipid syndrome in Covid19 - A complicate case of cardiogenic shock
We report a clinical case of multifactorial shock and primary adrenal insufficiency (PAI), caused by bilateral adrenal hemorrhage in the context of catastrophic antiphospholipid syndrome (CAPS) triggered by a COVID-19 infection. A 54-year-old woman was admitted with cardiogenic shock, presenting wit...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2025.1554009/full |
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| author | Giuseppe Fischetti Antonella Barbone Lorenzo Giovannico Giuseppe Palma Federica Mazzone Nicola Di Bari Domenico Parigino Luca Savino Ludovico Di Gioia Irene Caruso Aline Maria Silva Aldo Domenico Milano Massimo Padalino Tomaso Bottio Francesco Giorgino Sebastio Perrini Sebastio Perrini |
| author_facet | Giuseppe Fischetti Antonella Barbone Lorenzo Giovannico Giuseppe Palma Federica Mazzone Nicola Di Bari Domenico Parigino Luca Savino Ludovico Di Gioia Irene Caruso Aline Maria Silva Aldo Domenico Milano Massimo Padalino Tomaso Bottio Francesco Giorgino Sebastio Perrini Sebastio Perrini |
| author_sort | Giuseppe Fischetti |
| collection | DOAJ |
| description | We report a clinical case of multifactorial shock and primary adrenal insufficiency (PAI), caused by bilateral adrenal hemorrhage in the context of catastrophic antiphospholipid syndrome (CAPS) triggered by a COVID-19 infection. A 54-year-old woman was admitted with cardiogenic shock, presenting with severe cardiac dysfunction, neurological alterations, and systemic embolism. Despite initial treatment for suspected septic shock, her condition deteriorated, with bilateral adrenal hemorrhages, markedly elevated adrenocorticotropic hormone (ACTH) levels, low cortisol, and positive antiphospholipid antibodies, leading to the diagnosis of PAI. A multidisciplinary approach, including endocrinology and cardiology expertise, enabled the prompt initiation of hydrocortisone and anticoagulant therapy, which significantly improved her hemodynamic stability and overall clinical status. At follow-up, partial recovery of left ventricular function was observed, although residual cardiac dysfunction persisted. This case highlights the diagnostic challenges associated with CAPS, a rare autoimmune disorder with life-threatening manifestations, including PAI due to adrenal infarction. The overlapping symptoms of CAPS and septic shock often delay diagnosis, underscoring the importance of early recognition of adrenal involvement in patients with CAPS. Furthermore, the patient clinical history, including anticoagulant withdrawal and previous thrombotic events, suggests a need for heightened vigilance in similar cases. In recent years, strong evidence has emerged on the similarities between CAPS and COVID-19, particularly related to the immungenic power of this viral infection and hypercoagulability, but it is also considered that COVID-19 can trigger CAPS. Our findings emphasize the critical role of a coordinated multidisciplinary approach in managing complex CAPS presentations and underline the importance of timely hormone replacement and anticoagulation to improve outcomes in PAI associated with adrenal hemorrhage. |
| format | Article |
| id | doaj-art-e1eb4f32f195460bbaf5d9a1e2d939f4 |
| institution | DOAJ |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj-art-e1eb4f32f195460bbaf5d9a1e2d939f42025-08-20T03:09:45ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-04-011610.3389/fendo.2025.15540091554009Case Report: Primary adrenal insufficiency due to bilateral adrenal infarction and antiphospholipid syndrome in Covid19 - A complicate case of cardiogenic shockGiuseppe Fischetti0Antonella Barbone1Lorenzo Giovannico2Giuseppe Palma3Federica Mazzone4Nicola Di Bari5Domenico Parigino6Luca Savino7Ludovico Di Gioia8Irene Caruso9Aline Maria Silva10Aldo Domenico Milano11Massimo Padalino12Tomaso Bottio13Francesco Giorgino14Sebastio Perrini15Sebastio Perrini16Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Cardiac Surgery Unit, University of Bari “Aldo Moro”, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Disease, University of Bari Aldo Moro, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Cardiac Surgery Unit, University of Bari “Aldo Moro”, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Disease, University of Bari Aldo Moro, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Cardiac Surgery Unit, University of Bari “Aldo Moro”, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Cardiac Surgery Unit, University of Bari “Aldo Moro”, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Cardiac Surgery Unit, University of Bari “Aldo Moro”, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Cardiac Surgery Unit, University of Bari “Aldo Moro”, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Disease, University of Bari Aldo Moro, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Disease, University of Bari Aldo Moro, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Cardiac Surgery Unit, University of Bari “Aldo Moro”, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Cardiac Surgery Unit, University of Bari “Aldo Moro”, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Cardiac Surgery Unit, University of Bari “Aldo Moro”, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Cardiac Surgery Unit, University of Bari “Aldo Moro”, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Disease, University of Bari Aldo Moro, Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Disease, University of Bari Aldo Moro, Bari, ItalySection of Endocrinology, Department of Medicine and Surgery, Libera Università Mediterranea (LUM) University, Casamassima, Bari, ItalyWe report a clinical case of multifactorial shock and primary adrenal insufficiency (PAI), caused by bilateral adrenal hemorrhage in the context of catastrophic antiphospholipid syndrome (CAPS) triggered by a COVID-19 infection. A 54-year-old woman was admitted with cardiogenic shock, presenting with severe cardiac dysfunction, neurological alterations, and systemic embolism. Despite initial treatment for suspected septic shock, her condition deteriorated, with bilateral adrenal hemorrhages, markedly elevated adrenocorticotropic hormone (ACTH) levels, low cortisol, and positive antiphospholipid antibodies, leading to the diagnosis of PAI. A multidisciplinary approach, including endocrinology and cardiology expertise, enabled the prompt initiation of hydrocortisone and anticoagulant therapy, which significantly improved her hemodynamic stability and overall clinical status. At follow-up, partial recovery of left ventricular function was observed, although residual cardiac dysfunction persisted. This case highlights the diagnostic challenges associated with CAPS, a rare autoimmune disorder with life-threatening manifestations, including PAI due to adrenal infarction. The overlapping symptoms of CAPS and septic shock often delay diagnosis, underscoring the importance of early recognition of adrenal involvement in patients with CAPS. Furthermore, the patient clinical history, including anticoagulant withdrawal and previous thrombotic events, suggests a need for heightened vigilance in similar cases. In recent years, strong evidence has emerged on the similarities between CAPS and COVID-19, particularly related to the immungenic power of this viral infection and hypercoagulability, but it is also considered that COVID-19 can trigger CAPS. Our findings emphasize the critical role of a coordinated multidisciplinary approach in managing complex CAPS presentations and underline the importance of timely hormone replacement and anticoagulation to improve outcomes in PAI associated with adrenal hemorrhage.https://www.frontiersin.org/articles/10.3389/fendo.2025.1554009/fullcase reportprimary adrenal insufficiency (PAI)catastrophic antiphospholipid syndrome (CAPS)bilateral adrenal hemorrhagehormone replacement therapy |
| spellingShingle | Giuseppe Fischetti Antonella Barbone Lorenzo Giovannico Giuseppe Palma Federica Mazzone Nicola Di Bari Domenico Parigino Luca Savino Ludovico Di Gioia Irene Caruso Aline Maria Silva Aldo Domenico Milano Massimo Padalino Tomaso Bottio Francesco Giorgino Sebastio Perrini Sebastio Perrini Case Report: Primary adrenal insufficiency due to bilateral adrenal infarction and antiphospholipid syndrome in Covid19 - A complicate case of cardiogenic shock Frontiers in Endocrinology case report primary adrenal insufficiency (PAI) catastrophic antiphospholipid syndrome (CAPS) bilateral adrenal hemorrhage hormone replacement therapy |
| title | Case Report: Primary adrenal insufficiency due to bilateral adrenal infarction and antiphospholipid syndrome in Covid19 - A complicate case of cardiogenic shock |
| title_full | Case Report: Primary adrenal insufficiency due to bilateral adrenal infarction and antiphospholipid syndrome in Covid19 - A complicate case of cardiogenic shock |
| title_fullStr | Case Report: Primary adrenal insufficiency due to bilateral adrenal infarction and antiphospholipid syndrome in Covid19 - A complicate case of cardiogenic shock |
| title_full_unstemmed | Case Report: Primary adrenal insufficiency due to bilateral adrenal infarction and antiphospholipid syndrome in Covid19 - A complicate case of cardiogenic shock |
| title_short | Case Report: Primary adrenal insufficiency due to bilateral adrenal infarction and antiphospholipid syndrome in Covid19 - A complicate case of cardiogenic shock |
| title_sort | case report primary adrenal insufficiency due to bilateral adrenal infarction and antiphospholipid syndrome in covid19 a complicate case of cardiogenic shock |
| topic | case report primary adrenal insufficiency (PAI) catastrophic antiphospholipid syndrome (CAPS) bilateral adrenal hemorrhage hormone replacement therapy |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2025.1554009/full |
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