Experience in the treatment of acute adrenal insufficiency developed on COVID-19 (coronavirus infection) in a patient with diabetes

Introduction. The severity condition' of patients with COVID-19 largely depends on the multiplicity lesions and the involvement of vital organs, such as the adrenals, one of the most important components in the adaptation system in acute processes. Literary data indicate structural changes in the adrenals in patients with SARS-CoV-2, and the histological picture indicates the presence of focal necrosis of the adrenal glands and vasculitis of small veins. Studies on the assessment of adrenal function and damage in Covid-19 indicate the development of a chronic process in them. The objective of this study is to study a clinical case associated with the development of acute adrenal insufficiency in a patient with type 2 diabetes on COVID-19. Purpose. To study a clinical case related to the development of acute adrenal insufficiency in a patient with type 2 diabetes mellitus on the background of COVID-19. Material and methods. The source of the information was the primary medical documentation of patient E. «Medical record of a patient receiving medical care in an inpatient setting» (form 003/y). Results. On the 2nd day of hospitalization, signs pathognomonic for acute adrenal insufficiency appear: a swarthy tint of the skin, darkening of the skin folds on the hands, hyponatremia and arterial hypotension. The diagnosis was confirmed by the hormonal tests: ACTH = 63 PG/ml (0,0–46,0 PG/ml), morning cortisol blood = 68 nmol/l (185–624 nmol/l), daily urine cortisol = 55 µg/day (75–520 mg/day). Conclusions. This case describes clinical and laboratory data of acute primary adrenal insufficiency with complete restoration of adrenal function. Stabilization of the hormonal profile during inpatient treatment to parameters that do not require maintenance therapy with hormonal drugs in the future is a feature of this example. This case indicates the degree of the damaging effect of the virus, which can cause acute (reversible) primary adrenal insufficiency. In the presented clinical case shown that the development of adrenal insufficiency in COVID-19 is not always the beginning of a chronic process, even in patients with high comorbidity (type 2 diabetes). And with the timely start of active therapy, it's possible not only to preserve, but also to restore the function of the adrenal glands.