A case of unilateral post-COVID-19 adrenal haemorrhage and follow-up during pregnancies
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 unilate...
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| Format: | Article |
| Language: | English |
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Bioscientifica
2022-01-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM22-0337.xml |
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| author | Alessandra Mangone Quratulain Yousuf Wiebke Arlt Alessandro Prete Fozia Shaheen Senthil-kumar Krishnasamy Yasir S Elhassan Cristina L Ronchi |
| author_facet | Alessandra Mangone Quratulain Yousuf Wiebke Arlt Alessandro Prete Fozia Shaheen Senthil-kumar Krishnasamy Yasir S Elhassan Cristina L Ronchi |
| author_sort | Alessandra Mangone |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T05:17:15Z |
| format | Article |
| id | doaj.art-5613c1595bf14fbba4747a0abfdf2c69 |
| institution | Directory Open Access Journal |
| issn | 2052-0573 |
| language | English |
| last_indexed | 2024-04-11T05:17:15Z |
| publishDate | 2022-01-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-5613c1595bf14fbba4747a0abfdf2c692022-12-24T05:31:59ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732022-01-01111610.1530/EDM-22-0337A case of unilateral post-COVID-19 adrenal haemorrhage and follow-up during pregnanciesAlessandra Mangone0Quratulain Yousuf1Wiebke Arlt2Alessandro Prete3Fozia Shaheen4Senthil-kumar Krishnasamy5Yasir S Elhassan6Cristina L Ronchi7Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK University Hospitals of North Midlands NHS Trust, Stoke-on- Trent, UKInstitute of Metabolism and System Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UKInstitute of Metabolism and System Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UKInstitute of Metabolism and System Research, University of Birmingham, Birmingham, UKWalsall Healthcare NHS Trust, Walsall, UKInstitute of Metabolism and System Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UKInstitute of Metabolism and System Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology and Diabetes, University Hospital of Wurzburg, Wurzburg, GermanyThe 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.https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM22-0337.xml |
| spellingShingle | Alessandra Mangone Quratulain Yousuf Wiebke Arlt Alessandro Prete Fozia Shaheen Senthil-kumar Krishnasamy Yasir S Elhassan Cristina L Ronchi A case of unilateral post-COVID-19 adrenal haemorrhage and follow-up during pregnancies Endocrinology, Diabetes & Metabolism Case Reports |
| title | A case of unilateral post-COVID-19 adrenal haemorrhage and follow-up during pregnancies |
| title_full | A case of unilateral post-COVID-19 adrenal haemorrhage and follow-up during pregnancies |
| title_fullStr | A case of unilateral post-COVID-19 adrenal haemorrhage and follow-up during pregnancies |
| title_full_unstemmed | A case of unilateral post-COVID-19 adrenal haemorrhage and follow-up during pregnancies |
| title_short | A case of unilateral post-COVID-19 adrenal haemorrhage and follow-up during pregnancies |
| title_sort | case of unilateral post covid 19 adrenal haemorrhage and follow up during pregnancies |
| url | https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM22-0337.xml |
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