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 receiving glucocorticoid replacement therapy or can be a first presentation of adrenal insufficiency. Vaccination with tetanus, diphtheria, and pertussis, influenza, and pneumococcal vaccines has been reported as a cause of AC. Here, we aimed to present a case of AC precipitated by COVID-19 messenger RNA vaccination in a patient with hypopituitarism.
Case Report: A 74-year-old male patient with hypopituitarism received the second dose of the messenger RNA (BNT162b2) COVID-19 vaccine and after a few hours developed lethargy and confusion followed by fever. In the next day, the patient was more somnolent and unable to converse. His temperature and heart rate were 103.5 °F and 105 beats/min, respectively, and his blood pressure was 145/84 mm Hg, which decreased to 107/71 mm Hg. The patient was stuporous, responsive only to painful stimuli. A stress dose of glucocorticoids was started with improvement in all symptoms in 24 hours of treatment initiation.
Discussion: Vaccination with ChAdOx1 SARS-CoV-2 vaccine has been recognized as a cause of AC in patients with adrenal insufficiency. The present case report additionally demonstrates that different types of COVID-19 vaccines may be a cause of AC in patients with adrenal insufficiency.
Conclusion: A twofold to threefold increase in the maintenance dose of glucocorticoid is recommended if the patient is experiencing any symptom after COVID-19 vaccination. This treatment may reduce the risk of AC occurring after COVID-19 vaccination in patients with hypopituitarism.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9035659 | PMC |
| http://dx.doi.org/10.1016/j.aace.2022.04.004 | DOI Listing |
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