Clinical manifestation of cushing's disease after COVID-19 infection leading to the diagnosis of multiple endocrine neoplasia type 1

Background/objective

To understand the potential effects that severe acute respiratory syndrome coronavirus 2 (Sars-Cov-2) has on the endocrine system.

Case report

A 56-year-old female presented with complaints of increased appetite, generalized weakness, facial and neck swelling and a non-pruritic rash across her chest, abdomen and back. Onset of symptoms coincided with a Sars-Cov-2 infection three months prior to current admission. The physical exam revealed cushingoid features. Laboratory results confirmed Cushing's disease. Imaging studies revealed an 11 mm right-sided pituitary adenoma and mild thickening of the adrenals bilaterally. Additionally, a 9.4 × 7.9 cm mass was identified in the caudate lobe of the liver concerning for neoplastic origin. Liver biopsy confirmed a well differentiated neuroendocrine tumor. Endoscopy revealed chronic gastritis with hemorrhage and multiple oozing duodenal ulcers, along with an elevated gastrin level. Subsequently, the patient received a diagnosis of multiple endocrine neoplasia type 1 (MEN-1), attributed to the presence of endocrine tumors involving the anterior pituitary and gastroenteropancreatic tract.

Discussion

MEN-1 is a condition predisposing individual with two or more endocrine gland tumors primarily pituitary, parathyroid and gastroenteropancreatric tract. The clinical presentation varies and is often associated with hormone overproduction and tumor location. Coronavirus disease 2019 (COVID-19) is caused by Sars-Cov-2. Studies have shown to link Sars-Cov-2 with endocrinopathy.

Conclusion

The impact of SARS-CoV-2 extends beyond the respiratory system, highlighting the need for further research into its direct influence on the endocrine system.