Case Report: Adrenal Pathology Findings in Severe COVID-19: An Autopsy Study

Abstract

Although high mortality has been reported in many COVID-19 studies, very limited postmortem information from complete autopsies is available. We report the findings in the adrenal glands in 28 autopsies with confirmed SARS-CoV-2 infection. Microscopic lesions were identified in the adrenal glands in 12/28 patients (46%). Seven cases showed necrosis, generally ischemic; four showed cortical lipid degeneration; two showed hemorrhage; and one unspecific focal adrenalitis. Vascular thrombosis in one patient and focal inflammation in association with other findings in three patients were observed. No case presented adrenal insufficiency. In conclusion, adrenal lesions are frequent in patients with severe COVID-19. The lesions are mild but could contribute to the lethal outcome.

Figure 1.

Adrenal pathology autopsy findings in five severe COVID-19 patients. Enlarged right adrenal gland with extensive areas of hemorrhagic necrosis (A) (patient 8), bar = 2 cm. Histologic section of the adrenal with extensive adrenal hemorrhage (B) (patient 8), thrombi fibrin (C) (patient 8), hemorrhagic necrosis (D) (patient 2), focal adrenalitis (E) (patient 12), and adrenocortical carcinoma (F) (patient 4). Adrenal cortex with diffuse and severe cortical vacuolization of macro- and microvacuolar lipidic deposits (G) (patient 9). Hematoxylin–eosin–stained tissues observed under ×400 original magnification.