Table 1.

The PubMed-based, English language, full-length papers published between March 1, 2020 and November 1, 2021 concerning COVID-19 infection and AI with or without adrenal hemorrhage, with or without adrenal insufficiency related to COVID-19 infection

No.	Authors / reference	Type of study	No. of patients / age [years] / sex	Presentation	Endocrine aspects	COVID-19 aspects	Observations
1.	Freire Santana et al. / [58]	Post-mortem study (autopsy)	12 out of 28 (46%) patients with adrenal lesions	Autopsy diagnostic	No adrenal insufficiency based on cortisol levels (sample within 1–2 days before death)	COVID-19 as cause of death	Prior diagnostic of APLS
			50, 65 / F
			34, 35, 48, 52, 55, 57, 65, 66, 70, 88 / M
2.	Iuga et al. / [59]	Case series	5 patients / between 59 and 90 / F/M ratio: 1/4	Autopsy diagnostic	Not available	COVID-19 as cause of death	2 patients died of cardiac arrest at emergency room
							3 patients were hospitalized (maximum 72 hours) before death
3.	Machado et al. / [60]	Case report	1 patient / 46 / F	Abdominal pain, hypotension, skin hyperpigmentation	Na↓	AI after COVID-19 infection	CT scan: bilateral adrenal enlargement (infarction)
					Cortisol↓
					ACTH↑		Other contributors: prior autoimmune hepatitis, de novo positive anti-phospholipid antibodies
					Aldosterone↓
4.	Kumar et al. / [64]	Case report	1 patient / 70 / F	Fatigue, abdominal pain, vomiting, diarrhea	Na↓	Synchronous with COVID-19 pneumonia	CT: non-hemorrhagic AI
					On admission:  random ACTH, cortisol, K normal → then adrenal insufficiency		Other elements: negative anti-cardiolipin antibodies, history of HBP, hypercholesterolemia
5.	Elkhouly et al. / [67]	Case report	1 patient / 50 / M	Fever, malaise, dyspnea, cough, bilateral flank discomfort	Adrenal lesion was accidentally detected at CT	COVID-10 pneumonia, further complicated with deep vein thrombosis, massive pulmonary embolism causing the patient’s death	Previous diagnostic of HBP and right adrenal tumor
				On day 3 after hospitalization – hypotension
6.	Maria et al. / [68]	Case report	1 patient / 48 / M	Fever, cough, myalgia + sudden abdominal pain	Not available	COVID-19 pneumonia and limb arterial ischemia	Prior diagnostic of APLS
							The patient was under vitamin K antagonists at the moment of infection
7.	Frankel et al. / [69]	Case report	1 patient / 66 / F	Fever, dyspnea, abdominal pain, nausea, vomiting	Na↓	Synchronous with COVID-19 infection	CT: enlargement of adrenal glands
					Basal cortisol↓
					ACTH↑
8.	Leyendecker et al. / [80]	Retrospective study (March 9–April 10, 2020)	51 out of 219 (23%) patients with CT for lung involvement / mean age 67±11 / 71% M	Detection as incidental CT finding	8% adrenal insufficiency	Synchronous with COVID-19 with severe/critical lung disease	CT: bilateral lesions in 88% of cases
				Correlation with a longer hospital stay versus without
9.	Hanley et al. / [81]	Retrospective (post-mortem) study (March 1–April 30, 2020)	9 patients / 73 (IQR 52–79) / 7 M, 3 F	Death due to SARS		Adrenal involvement confirmed at post-mortem analysis	Multiple organ involvement
10.	Álvarez-Troncoso et al. / [85]	Case report	1 patient / 70 / M	Fever, chills, asthenia, constipation, malaise, generalized weakness, anorexia, nausea, vomiting	Na↓	Synchronous with COVID-19 bilateral bronchopneumonia	CT: bilateral enlargement of adrenal glands (with blurring aspect)
				Hypotensive	No hormonal assessment due to glucocorticoids therapy
11.	Sharrack et al. / [86]	Case report	1 patient / 53 / M	Fever, dyspnea, pleuritic chest pain	Normal short Synacthen test	COVID-19-related bilateral pulmonary embolism	CT: right adrenal hemorrhage confirmed during infection and remitted at CT scan performed after five months

ACTH: Adrenocorticotropic hormone; AI: Adrenal infarction; APLS: Antiphospholipid syndrome; COVID-19: Coronavirus disease 2019; CT: Computed tomography; F: Female; HBP: High blood pressure; IQR: Interquartile range; K: Potassium; M: Male; Na: Sodium; SARS: Severe acute respiratory syndrome