key: cord-0792136-q90fd5rk
authors: Markovic, Nikolina; Faizan, Anila; Boradia, Chirag; Nambi, Sridhar
title: Adrenal crisis secondary to Covid-19 vaccination in patient with hypopituitarism
date: 2022-04-25
journal: AACE Clin Case Rep
DOI: 10.1016/j.aace.2022.04.004
sha: e8ff36c9fca34ff399afdc255db0dea48093c140
doc_id: 792136
cord_uid: q90fd5rk

BACKGROUND/OBJECTIVE: Adrenal crisis (AC) is an acute life-threatening condition that can occur in patients with primary or secondary adrenal insufficiency who are already on glucocorticoid replacement therapy or can be a first presentation of adrenal insufficiency. Vaccination with Tdap, influenza and pneumococcal vaccine has been reported as a cause of AC. Our objective is to present a case of AC precipitated by COVID-19 mRNA vaccination in patient with hypopituitarism. CASE PRESENTATION: 74-year-old male with hypopituitarism received second dose of mRNA (BNT162b2) COVID-19 vaccine and in few hours developed lethargy and confusion followed by fever. The next day patient was more somnolent and being unable to converse. Emergency medical service was called, and patient was found to have blood glucose of 20 mg/dl. In the emergency department his temperature was 103.5F, heart rate 105 beats/minute, blood pressure 145/84 mmHg which decreased to 107/71 mmHg. Patient was stuporous, responsive only to painful stimuli. Stress dose of glucocorticoids was started with improvement in all symptoms in 24 hours of treatment initiation. DISCUSSION: Recently case series of 5 cases of AC secondary to ChAdOx1 SARS‐CoV‐2 vaccination were published. Case report described here additionally demonstrate that different types of COVID-19 vaccine may be a cause of AC in patients with adrenal insufficiency. CONCLUSION: Two to three-fold increase in the maintenance dose of glucocorticoid is probably needed if patient is experiencing any symptoms after COVID-19 vaccination. This treatment may reduce the probability of AC occurring after COVID-19 vaccination in patients with hypopituitarism.

vaccine and in few hours developed lethargy and confusion followed by fever. The next day 10 patient was more somnolent and being unable to converse. Emergency medical service was called, 11 and patient was found to have blood glucose of 20 mg/dl. In the emergency department his 

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Prior presentation: Abstract of this case report was presented on local 19 th Annual Department of Medicine Research Day at Rutgers New Jersey Medical School as poster presentation.

All authors declare no conflict of interest.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.