Adrenal Insufficiency in Coronavirus Disease 2019 (COVID-19)-Infected Patients without Preexisting Adrenal Diseases: A Systematic Literature Review

Table 1

Summary of peer-reviewed cross-sectional studies reporting adrenal insufficiency in patients infected with COVID-19.

Authors	Date	Design	Sample size N (%)		Male (%)	Age (years)	Adrenal insufficiency assessment findings		Adrenal insufficiency type	Adrenal insufficiency frequency (%)
							Laboratory data	Radiographic findings
Alzahrani et al. [25]	7 May –20 May 2020	Cross-sectional	Total	28 (100)	16 (57.1)	Median: 45.5 (range: 25–69)	Median cortisol: 196 (range: 31–587) nmol/l	NA	Central	Days 1–2: 18 out of 28 (64.3)
							Median ACTH: 18.5 (range: 4–38) ng/l			Days 3–5: 9 out of 20 (45)
							Cortisol< 100 nmol/l: 8 (28.6%)
							Cortisol< 200 nmol/l: 14 (50%)			Days 8–11: 9 out of 15 (60)
							Cortisol< 300 nmol/l: 18 (64.3%)
							ACTH<10 ng/l: 7 (26.9)
							ACTH<20 ng/l: 17 (60.7%)
							ACTH<30 ng/l: 23 (82.1%)
Leyendecker et al. [26]	9 March –10 April 2020	Cross-sectional	Total	219 (100)	NA		Combination of hyperkalemia (>5 mmol/L), hyponatremia (<130 mmol/L), and hypoglycemia (<3.9 mmol/L)	Enlargement of adrenal glands with peripheral fat stranding in suprarenal region	NA	7 (3.1)
			Acute adrenal infarction	51 (23)	36 (70.5)	67 ± 11 (range: 42–88)				4 (7.8)
			No acute adrenal infarction	168 (77)	123 (73.2)	67 ± 15 (range: 22–96)				3 (1.7)
Mao et al. [27]	1 March –1 May 2020	Cross-sectional	Total	21 (100)	5 (23.8)	NA	Cortisol<10 µg/dl	NA	NA	NA
			COVID-19 group	9 (42.9)	1 (11.1)	71.7 ± 8.1				6 (66.6)
			Non COVID-19	12 (57.1)	4 (33.3)	68.9 ± 20.2				NA

ACTH: adrenocorticotropic hormone; NA: not available. Adrenal insufficiency was suggested to be in context of critical illness-related corticosteroid insufficiency.