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Post-COVID-19 syndrome increased the requirement for corticosteroids in a dialysis patient with preexisting adrenal insufficiency

A 77-year-old male patient on maintenance hemodialysis therapy who underwent unilateral adrenonephrectomy 9 years ago was transferred to our hospital after 4 months of acute treatment for skull base osteomyelitis. He presented with unexplained hypotension during dialysis sessions. Further evaluation...

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Autor principal: Eguchi, Eriko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Nature Singapore 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9826535/
https://www.ncbi.nlm.nih.gov/pubmed/36617353
http://dx.doi.org/10.1007/s13730-023-00772-z
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author Eguchi, Eriko
author_facet Eguchi, Eriko
author_sort Eguchi, Eriko
collection PubMed
description A 77-year-old male patient on maintenance hemodialysis therapy who underwent unilateral adrenonephrectomy 9 years ago was transferred to our hospital after 4 months of acute treatment for skull base osteomyelitis. He presented with unexplained hypotension during dialysis sessions. Further evaluation led to a diagnosis of primary adrenal insufficiency, followed by the start of oral hydrocortisone. Six months after admission, the patient was found to have a positive COVID-19 result on a rapid antigen test and mild symptoms. The patient complained of fatigue after the disappearance of the symptoms. Subsequently, the systolic blood pressure gradually declined despite the additional administration of fludrocortisone and caused difficulties in undergoing hemodialysis. The patient’s lasting fatigue raised a suspicion of post-COVID-19 syndrome, requiring larger dosages of corticosteroids by stress dosing. Hypotension was interpreted as a symptom associated with adrenal insufficiency. The dosages of corticosteroids were increased beyond the upper recommended limits. The effect eventually stabilized the patient’s hemodynamics. Hydrocortisone was increased as follows: 35 mg/day for nondialysis days and 55 mg/day for dialysis days, divided into three or four doses per day (20 mg in the morning, 20 mg before dialysis, 10 mg in the afternoon, and 5 mg in the evening). The dosage of fludrocortisone was increased up to 0.5 mg/day. In conclusion, the requirement for corticosteroids significantly increased in association with post-COVID-19 syndrome. The management of patients with adrenal insufficiency in the context of concomitant post-COVID-19 syndrome needs further investigation.
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spelling pubmed-98265352023-01-09 Post-COVID-19 syndrome increased the requirement for corticosteroids in a dialysis patient with preexisting adrenal insufficiency Eguchi, Eriko CEN Case Rep Case Report A 77-year-old male patient on maintenance hemodialysis therapy who underwent unilateral adrenonephrectomy 9 years ago was transferred to our hospital after 4 months of acute treatment for skull base osteomyelitis. He presented with unexplained hypotension during dialysis sessions. Further evaluation led to a diagnosis of primary adrenal insufficiency, followed by the start of oral hydrocortisone. Six months after admission, the patient was found to have a positive COVID-19 result on a rapid antigen test and mild symptoms. The patient complained of fatigue after the disappearance of the symptoms. Subsequently, the systolic blood pressure gradually declined despite the additional administration of fludrocortisone and caused difficulties in undergoing hemodialysis. The patient’s lasting fatigue raised a suspicion of post-COVID-19 syndrome, requiring larger dosages of corticosteroids by stress dosing. Hypotension was interpreted as a symptom associated with adrenal insufficiency. The dosages of corticosteroids were increased beyond the upper recommended limits. The effect eventually stabilized the patient’s hemodynamics. Hydrocortisone was increased as follows: 35 mg/day for nondialysis days and 55 mg/day for dialysis days, divided into three or four doses per day (20 mg in the morning, 20 mg before dialysis, 10 mg in the afternoon, and 5 mg in the evening). The dosage of fludrocortisone was increased up to 0.5 mg/day. In conclusion, the requirement for corticosteroids significantly increased in association with post-COVID-19 syndrome. The management of patients with adrenal insufficiency in the context of concomitant post-COVID-19 syndrome needs further investigation. Springer Nature Singapore 2023-01-08 /pmc/articles/PMC9826535/ /pubmed/36617353 http://dx.doi.org/10.1007/s13730-023-00772-z Text en © The Author(s) under exclusive licence to The Japan Society of Nephrology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
spellingShingle Case Report
Eguchi, Eriko
Post-COVID-19 syndrome increased the requirement for corticosteroids in a dialysis patient with preexisting adrenal insufficiency
title Post-COVID-19 syndrome increased the requirement for corticosteroids in a dialysis patient with preexisting adrenal insufficiency
title_full Post-COVID-19 syndrome increased the requirement for corticosteroids in a dialysis patient with preexisting adrenal insufficiency
title_fullStr Post-COVID-19 syndrome increased the requirement for corticosteroids in a dialysis patient with preexisting adrenal insufficiency
title_full_unstemmed Post-COVID-19 syndrome increased the requirement for corticosteroids in a dialysis patient with preexisting adrenal insufficiency
title_short Post-COVID-19 syndrome increased the requirement for corticosteroids in a dialysis patient with preexisting adrenal insufficiency
title_sort post-covid-19 syndrome increased the requirement for corticosteroids in a dialysis patient with preexisting adrenal insufficiency
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9826535/
https://www.ncbi.nlm.nih.gov/pubmed/36617353
http://dx.doi.org/10.1007/s13730-023-00772-z
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