{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T05:55:36Z","timestamp":1773381336750,"version":"3.50.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T00:00:00Z","timestamp":1598227200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T00:00:00Z","timestamp":1598227200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Novel coronavirus disease 2019 presents with fever, dry cough, fatigue, and shortness of breath in most cases; however, some rare manifestations in other organs have also been reported so far.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>Here, the case of a 69-year-old\u00a0Iranian man with coronavirus disease 2019 is presented who suffered from frequent episodes of vasopressor-resistant hypotension during intensive care unit admission, which was finally attributed to the occurrence of acute adrenal insufficiency.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>As this is a rare complication, adrenal insufficiency might be easily overlooked. However, early detection of this disease among critically ill patients infected with coronavirus disease 2019 could be lifesaving, especially among those unresponsive to vasopressor agents.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13256-020-02461-2","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T14:03:06Z","timestamp":1598277786000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Adrenal insufficiency in coronavirus disease 2019: a case report"],"prefix":"10.1186","volume":"14","author":[{"given":"Maryam","family":"Heidarpour","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehrbod","family":"Vakhshoori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saeed","family":"Abbasi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davood","family":"Shafie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nima","family":"Rezaei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,8,24]]},"reference":[{"issue":"10223","key":"2461_CR1","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","volume":"395","author":"C Huang","year":"2020","unstructured":"Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497\u2013506.","journal-title":"Lancet"},{"key":"2461_CR2","doi-asserted-by":"crossref","unstructured":"Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, Bi Z, Zhao Y. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109(5):531\u20138.","DOI":"10.1007\/s00392-020-01626-9"},{"key":"2461_CR3","unstructured":"World Health Organization. Coronavirus disease 2019 (COVID-19), Situation Report \u2013 97 2020, April 26 [Available from: https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200426-sitrep-97-covid-19.pdf?sfvrsn=d1c3e800_6. Accessed 26 Apr 2020."},{"issue":"9","key":"2461_CR4","doi-asserted-by":"publisher","first-page":"887","DOI":"10.2174\/138945009789108792","volume":"10","author":"M Annetta","year":"2009","unstructured":"Annetta M, Maviglia R, Proietti R, Antonelli M. Use of corticosteroids in critically ill septic patients: a review of mechanisms of adrenal insufficiency in sepsis and treatment. Curr Drug Targets. 2009;10(9):887\u201394.","journal-title":"Curr Drug Targets"},{"issue":"6","key":"2461_CR5","doi-asserted-by":"publisher","first-page":"1937","DOI":"10.1097\/CCM.0b013e31817603ba","volume":"36","author":"PE Marik","year":"2008","unstructured":"Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, Keh D, Briegel J, Beishuizen A, Dimopoulou I. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008;36(6):1937\u201349.","journal-title":"Crit Care Med"},{"issue":"8","key":"2461_CR6","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1056\/NEJMra020529","volume":"348","author":"MS Cooper","year":"2003","unstructured":"Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med. 2003;348(8):727\u201334.","journal-title":"N Engl J Med"},{"issue":"1","key":"2461_CR7","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1210\/edrv-10-1-92","volume":"10","author":"A Bateman","year":"1989","unstructured":"Bateman A, Singh A, Kral T, Solomon S. The immune-hypothalamic-pituitary-adrenal axis. Endocr Rev. 1989;10(1):92\u2013112.","journal-title":"Endocr Rev"},{"issue":"3","key":"2461_CR8","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/S0002-9343(99)80373-8","volume":"98","author":"A Soni","year":"1995","unstructured":"Soni A, Pepper GM, Wyrwinski PM, Ramirez NE, Simon R, Pina T, Gruenspan H, Vaca CE. Adrenal insufficiency occurring during septic shock: incidence, outcome, and relationship to peripheral cytokine levels. Am J Med. 1995;98(3):266\u201371.","journal-title":"Am J Med"},{"issue":"6","key":"2461_CR9","doi-asserted-by":"publisher","first-page":"3084","DOI":"10.1210\/endo-125-6-3084","volume":"125","author":"R Natarajan","year":"1989","unstructured":"Natarajan R, Ploszaj S, Horton R, Nadler J. Tumor necrosis factor and interleukin-1 are potent inhibitors of angiotensin-II-induced aldosterone synthesis. Endocrinology. 1989;125(6):3084\u20139.","journal-title":"Endocrinology."},{"issue":"8","key":"2461_CR10","doi-asserted-by":"publisher","first-page":"1688","DOI":"10.1097\/01.CCM.0000171183.79525.6B","volume":"33","author":"J-Y Chien","year":"2005","unstructured":"Chien J-Y, Jerng J-S, Yu C-J, Yang P-C. Low serum level of high-density lipoprotein cholesterol is a poor prognostic factor for severe sepsis. Crit Care Med. 2005;33(8):1688\u201393.","journal-title":"Crit Care Med"},{"issue":"12","key":"2461_CR11","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1007\/s00134-017-4919-5","volume":"43","author":"D Annane","year":"2017","unstructured":"Annane D, Pastores SM, Rochwerg B, Arlt W, Balk RA, Beishuizen A, Briegel J, Carcillo J, Christ-Crain M, Cooper MS. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med. 2017;43(12):1751\u201363.","journal-title":"Intensive Care Med"},{"issue":"5","key":"2461_CR12","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1016\/j.mehy.2004.04.009","volume":"63","author":"R Wheatland","year":"2004","unstructured":"Wheatland R. Molecular mimicry of ACTH in SARS\u2013implications for corticosteroid treatment and prophylaxis. Med Hypotheses. 2004;63(5):855\u201362.","journal-title":"Med Hypotheses"},{"issue":"2","key":"2461_CR13","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1111\/j.1365-2265.2005.02325.x","volume":"63","author":"MKS Leow","year":"2005","unstructured":"Leow MKS, Kwek DSK, Ng AWK, Ong KC, Kaw GJL, Lee LSU. Hypocortisolism in survivors of severe acute respiratory syndrome (SARS). Clin Endocrinol. 2005;63(2):197\u2013202.","journal-title":"Clin Endocrinol"},{"key":"2461_CR14","doi-asserted-by":"crossref","unstructured":"Pal R. COVID-19, hypothalamo-pituitary-adrenal axis and clinical implications. Endocrine. 2020;1.","DOI":"10.1007\/s12020-020-02325-1"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-020-02461-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-020-02461-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-020-02461-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T00:38:23Z","timestamp":1629765503000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-020-02461-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,24]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["2461"],"URL":"https:\/\/doi.org\/10.1186\/s13256-020-02461-2","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,24]]},"assertion":[{"value":"18 May 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 July 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval is not necessary for retrospective studies and case presentations in our institutional policies.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient\u2019s next of kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None of the authors had any personal or financial conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"134"}}