Cardiff University | Prifysgol Caerdydd ORCA
Online Research @ Cardiff 
WelshClear Cookie - decide language by browser settings

COVID-19-related Adrenal haemorrhage multicentre UK experience and systematic review of the literature

Elhassan, Yasir S., Iqbal, Fizzah, Arlt, Wiebke, Baldeweg, Stephanie E., Levy, Miles, Stewart, Paul M., Wass, John, Pavord, Sue, Rees, D. Aled ORCID: and Ronchi, Cristina L. 2023. COVID-19-related Adrenal haemorrhage multicentre UK experience and systematic review of the literature. Clinical Endocrinology 98 (6) , pp. 766-778. 10.1111/cen.14881

[thumbnail of Clinical Endocrinology - 2023 - Elhassan - COVID‐19‐related adrenal haemorrhage  Multicentre UK experience and systematic.pdf]
PDF - Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (692kB) | Preview


Objective Adrenal haemorrhage (AH) is an uncommon, usually incidental imaging finding in acutely unwell patients. AH has been reported during coronavirus disease 2019 (COVID-19) infection and following ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccination. The Society for Endocrinology (SfE) established a task force to describe the UK experience of COVID-19-related AH. Design A systematic literature review was undertaken. A survey was conducted through the SfE clinical membership to identify patients with COVID-19-related AH using a standardized data collection tool. Results The literature search yielded 25 cases of COVID-19-related AH (19 bilateral; 13 infection-related, and 12 vaccine-related). Eight UK centres responded to the survey with at least one case. A total of 18 cases were included in the descriptive study, including 11 from the survey and 7 UK-based patients from the systematic review. Seven patients (4 males; median age 53 (range 26–70) years), had infection-related AH (four bilateral). Median time from positive COVID-19 test to AH detection was 8 (range 1–30) days. Eleven cases of vaccine-related AH (eight bilateral) were captured (3 males; median age 47 (range 23–78) years). Median time between vaccination (nine Oxford-AstraZeneca and two Pfizer-BioNTech) and AH was 9 (range 2–27) days; 9/11 AH occurred after the first vaccine dose. Acute abdominal pain was the commonest presentation (72%) in AH of any cause. All 12 patients with bilateral AH and one patient with unilateral AH required glucocorticoid replacement. Conclusion Adrenal haemorrhage with consequential adrenal insufficiency can be a complication of COVID-19 infection and vaccination. Adrenal function assessment is mandatory to avoid the potentially fatal consequences of unrecognized adrenal insufficiency.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Neuroscience and Mental Health Research Institute (NMHRI)
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Publisher: Wiley
ISSN: 0300-0664
Date of First Compliant Deposit: 24 January 2023
Date of Acceptance: 22 January 2023
Last Modified: 11 Jul 2023 16:21

Actions (repository staff only)

Edit Item Edit Item


Downloads per month over past year

View more statistics