POSACONAZOLE INDUCED PSEUDOHYPERALDOSTERONISM WITH CONCURRENT ACUTE PRIMARY ADRENAL INSUFFICIENCY-A CASE REPORT

In this covid 19 pandemic,there were increased incidence of Mucormycosis and thereby increase in usage of antifungals especially oral posaconazole which is more recently available in tablet form.There are already enough case reports of the incidence of new onset hypertension and hypokalemia with supressed renin and aldosterone which is termed as “Posaconazole induced pseudohyperaldosteronism”.We describe here about a similar case that presented with hypertensive urgency as Acute pulmonary edema with an associated primary adrenal insufciency.The potential mechanism include inhibition of 11 β HSD which degrades cortisol to cortisone,thereby increasing the levels of cortisol that stimulates Mineralocorticoid receptor.Also there is inhibition of steroidogenesis at the level of adrenal which in our patient presented with features of Acute adrenal insufciency.

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Primary adrenal insufficiency due to bilateral adrenal infarction in COVID-19: a case report

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab557 ◽

2021 ◽

Author(s):

Iza F R Machado ◽

Isabel Q Menezes ◽

Sabrina R Figueiredo ◽

Fernando Morbeck Almeida Coelho ◽

Debora R B Terrabuio ◽

...

Keyword(s):

Case Report ◽

Adrenal Insufficiency ◽

Antiphospholipid Syndrome ◽

Antiphospholipid Antibodies ◽

Case Reports ◽

Serum Cortisol ◽

Primary Adrenal Insufficiency ◽

Acute Adrenal Insufficiency ◽

Adrenal Infarction ◽

New Onset

Abstract Context Coronavirus disease 2019 (COVID-19) is a proinflammatory and prothrombotic condition, but its impact on adrenal function has not been adequately evaluated. Case report A 46-year-old woman presented with abdominal pain, hypotension, skin hyperpigmentation after COVID-19 infection. The patient had hyponatremia, serum cortisol <1.0 ug/dL, ACTH of 807 pg/mL and aldosterone <3 ng/dL. Computed tomography (CT) findings of adrenal enlargement with no parenchymal and minimal peripheral capsular enhancement after contrast were consistent with bilateral adrenal infarction. The patient had autoimmune hepatitis and positive antiphospholipid antibodies, but no previous thrombotic events. The patient was treated with intravenous hydrocortisone, followed by oral hydrocortisone and fludrocortisone. Discussion Among 115 articles, we identified nine articles, including case reports, of new-onset adrenal insufficiency and/or adrenal hemorrhage/infarction on CT in COVID-19. Adrenal insufficiency was hormonally diagnosed in five cases, but ACTH levels were measured in only three cases (high in one case and normal/low in other two cases). Bilateral adrenal non- or hemorrhagic infarction was identified in five reports (two had adrenal insufficiency, two had normal cortisol levels and one case had no data). Interestingly, the only case with well-characterized new-onset acute primary adrenal insufficiency after COVID-19 had a previous diagnosis of antiphospholipid syndrome. In our case, antiphospholipid syndrome diagnosis was established only after the adrenal infarction triggered by COVID-19. Conclusions Our findings support the association between bilateral adrenal infarction and antiphospholipid syndrome triggered by COVID-19. Therefore, patients with positive antiphospholipid antibodies should be closely monitored for symptoms or signs of acute adrenal insufficiency during COVID-19.

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Abstract #129: New Onset Siadh S/P Bilateral VP Shunt with Pre-Existing Primary Adrenal Insufficiency

Endocrine Practice ◽

10.1016/s1530-891x(20)42498-x ◽

2015 ◽

Vol 21 ◽

pp. 16-17

Author(s):

Jeremy Bleicher

Keyword(s):

Adrenal Insufficiency ◽

Primary Adrenal Insufficiency ◽

Vp Shunt ◽

New Onset

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Acute pulmonary edema as the initial presentation of a pheochromocytoma: case report

Endocrine Abstracts ◽

10.1530/endoabs.32.p235 ◽

2013 ◽

Author(s):

Eduarda Resende ◽

Maritza Sa ◽

Margarida Ferreira ◽

Silvestre Abreu

Keyword(s):

Case Report ◽

Pulmonary Edema ◽

Initial Presentation ◽

Acute Pulmonary Edema

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Oxytocin-Induced Acute Pulmonary Edema: A Case Report and Literature Review

Cureus ◽

10.7759/cureus.15067 ◽

2021 ◽

Author(s):

Mohamed K Mansour ◽

Mohamed Dehelia ◽

Yousif M Hydoub ◽

Omar Kousa ◽

Babar Hassan

Keyword(s):

Case Report ◽

Literature Review ◽

Pulmonary Edema ◽

Acute Pulmonary Edema

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An unusual presentation of primary adrenal insufficiency with new onset type 1 diabetes: case report and review of the literature

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0193 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Shelby Graf ◽

Rachel Stork Poeppelman ◽

Jennifer McVean ◽

Arpana Rayannavar ◽

Muna Sunni

Keyword(s):

Type 1 Diabetes ◽

Adrenal Insufficiency ◽

Diabetic Ketoacidosis ◽

Serum Cortisol ◽

Unusual Presentation ◽

Primary Adrenal Insufficiency ◽

Onset Type ◽

Autoimmune Conditions ◽

New Onset

Abstract Objectives To describe an atypical presentation of primary adrenal insufficiency in conjunction with new onset type 1 diabetes. Case presentation Here, we describe a case of new-onset type 1 diabetes (T1D) presenting simultaneously with an unusual presentation of primary adrenal insufficiency in a previously healthy 16-year-old. He was admitted for a typical presentation of diabetic ketoacidosis, but with extreme hyponatremia. An extensive workup revealed a low aldosterone level, appropriate cortisol level, and positive 21-hydroxylase antibodies. While the phenomenon of multiple autoimmune conditions developing in the same patient is well-described, this particular case has several atypical aspects. Our patient’s case highlights the danger of relying on random serum cortisol in the setting of acute illness to rule out adrenal insufficiency. Conclusions Adrenal insufficiency can present as isolated hypoaldosteronism without hypocortisolemia and can manifest as severe hyponatremia in the context of diabetic ketoacidosis. Workup for an unusual presentation of T1D should include a 21-hydroxylase antibody, as well as thyroid and celiac disease studies.

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