Endocrine Abstracts

The COVID-19 vaccine plays an important role in managing the pandemic. Unfortunately, there are endocrine side effects also noted. The 36-year-old lady felt unwell 2 weeks post-AstraZeneca COVID-19 vaccine. She got admitted to the hospital after 6weeks with persistent vomiting and significant hyponatremia. She has a past history of well-controlled asthma and hypothyroidism. Random cortisol on admission was 31 nmol/l, and a short synacthen test(SST) confirmed adrenal insufficiency. She was on steroid inhaler at this stage. Repeat SST, after withholding steroid inhaler, was consistent with adrenal insufficiency. She was treated with IV hydrocortisone during admission and discharged on oral prednisolone. On further workup, adrenal auto-antibodies were negative. MRI(adrenals) showed normal adrenal glands. There was no evidence of pituitary adenoma on the MRI(pituitary) with the normal pituitary biochemical profile. Previously, cases were reported with Covid vaccine-induced immune thrombocytopenia and thrombosis, leading to adrenal haemorrhage and infarction. Notably, the AstraZeneca vaccine has been recognized as a cause of adrenal crisis in known adrenal insufficiency. Furthermore, a case report of new-onset adrenal insufficiency in patients with COVID-19 has been reported. Regarding the pathophysiology of COVID-19, S glycoprotein binds to ACE2 receptors in many tissues, including lungs, heart and blood vessels, adrenal glands, etc. On the other hand, AstraZeneca Vaccine comprises chimpanzee adenovirus(ChAdOx1) vector encoding S glycoprotein of SARS-CoV-2. In our case, the pathophysiology is unclear, but arguably, there might be the likelihood of S glycoprotein from AstraZeneca Vaccine binding to our patient’s adrenal gland and attributing to adrenalitis.

Conclusion: In this interesting case, we can conclude that it was due to possible adrenalitis associated with the COVID-19 vaccine.