ECE2021 Audio Eposter Presentations Adrenal and Cardiovascular Endocrinology (80 abstracts)
Incidental detection of adrenal hyperplasia and mortality in patients with suspected SARS-CoV-2 Infection
Giuseppe Reimondo 1 , Federica Solitro 2 , Soraya Puglisi 1 , Davide Casale 2 , Giorgia Maria Tiranti 2 , Anna Perini 1 , Alessandra Cultrera 1 , Valeria Caramello 3 , Adriana Boccuzzi 3 , Anna Pia 1 , Massimo Terzolo 1 & Andrea Veltri 2
1Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy; 2Diagnostic and Interventional Radiology Unit, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy; 3Emergency Medicine, San Luigi Gonzaga Hospital, Orbassano, Italy
Many patients affected by SARS-CoV-2 disease (COVID) have associated comorbidities (arterial hypertension, obesity, diabetes mellitus, thrombophilia) that are also tied to autonomous cortisol secretion. However, the prevalence of diseases of the adrenal glands in COVID patients is presently unknown. Since the visualization of the adrenal glands is almost always available in chest CT performed in patients with suspected or confirmed SARS-CoV-2 infection, the evaluation of adrenal morphological disorders in such patients appears of interest. We assessed a prospective consecutive series of 402 patients (M 222, 55.2%; F 180, 44.8%) with a median age of 76 years (IQR 64–84 years), admitted to the emergency department for suspected SARS-CoV-2 infection. One hundred patients had a PCR-confirmed diagnosis of infection on a nasopharyngeal swab (24.9%). All patients underwent a chest CT study including the adrenal region. We found an altered adrenal morphology in 100 patients (24.9%): 62 subjects (15.4%) had adrenal hyperplasia (67.7% unilateral, 32.3% bilateral) and 38 (9.5%) discrete adrenal nodules (89.4% unilateral, 10.6% bilateral). The median size of adrenal nodules was 16 mm (10–50 mm) with a median density of 10 HU (-41–42 HU). In 17 patients with adrenal hyperplasia, a previous CT was available for comparison: in all cases an increase in thickness was evident at admission (median increase 1.95 mm, range 1–15). COVID patients had a non-significant higher frequency of adrenal nodules and hyperplasia (12% vs 8.6%, P = NS and 17% vs 12%, P = NS, respectively). Sixty-three patients (16%) died. They were older (80 vs 74 years, P = 0.001), had a higher frequency of adrenal hyperplasia (25% vs 14%, P = 0.03), more frequent active cancer disease (37% vs 19%, P = 0.003) and COVID (23% vs 13.2%, P = 0.02). In a multivariate model, adrenal hyperplasia is an independent risk factor for mortality (OR 2.52, 1.15–5.55, P = 0.02), as well as age (OR 1.04, 1.01–1.07, P = 0.005), active oncological disease (OR 3.06, 1.44–6.49, P = 0.004), and COVID (OR 2.88, 1.38–6.01, P = 0.005). This is the first study reporting the prevalence of morphological alterations of adrenal glands in suspected COVID patients. The frequency of discrete adrenal nodules (9.5%) is in line with the high prevalence of adrenal incidentalomas in elder subjects. The finding that adrenal hyperplasia is associated with an increased risk of mortality suggests that it may be the consequence of an exaggerated activation of the HPA axis due to a highly stressful condition.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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