Nikhil Prasad Fact checked by:Thailand Medical News Team Aug 26, 2026 55 minutes ago
A new systematic review suggests COVID-19 can be followed by adrenal insufficiency in people who had no previous adrenal disease. The condition can potentially become life-threatening because the body does not produce enough cortisol, a hormone essential for maintaining blood pressure and helping the body respond to physical stress.
A systematic review suggests COVID-19 may rarely be followed by potentially serious adrenal insufficiency in people with
no previous adrenal disease
The review examined reports involving both adults and children, including patients who developed adrenal problems during active COVID-19 and others who became ill weeks or months after recovering.
What the Review Found
Investigators searched PubMed/MEDLINE, Scopus, and Web of Science for relevant studies through December 28, 2025. Nine primary studies qualified for the final analysis: two observational studies and seven case reports. Four narrative reviews were considered only for background information.
The findings showed several different patterns of adrenal insufficiency. The most frequently reported form among biochemically confirmed cases was central, or secondary, adrenal insufficiency. This occurs when the brain's hormonal control system does not properly signal the adrenal glands to produce sufficient cortisol.
A smaller number of patients developed primary adrenal insufficiency involving damage to the adrenal glands themselves. Reported causes included adrenal infarction, in which blood supply to adrenal tissue is blocked, hemorrhage, and autoimmune adrenal inflammation.
Importantly, cases occurred across COVID-19 severity levels, ranging from mild disease to critical illness. Post-COVID diagnoses were reported particularly frequently.
Symptoms Can Resemble Long COVID
Recognizing adrenal insufficiency can be difficult because symptoms may resemble COVID-19 complications or long COVID. Warning signs described across the literature included persistent fatigue, low blood pressure, low blood sodium, cognitive symptoms, circulatory instability, and shock.
As highlighted in this
Thailand Medical News report, most biochemically confirmed patients improved after receiving glucocorticoid replacement, which provides the steroid hormones the body is failing to produce adequately.
However, the review also stressed an important uncertainty. Some patients diagnosed largely because they were in shock and improved after steroids did not undergo sufficient hormonal testing. These cases may instead represent critical illness-related corticosteroid insufficiency, a temporary failure of the body's stress-hormone response, rather than classical adrenal disease.
How COVID-19 Could Affect the Adrenal System
Several mechanisms may be involved. COVID-19 can produce severe inflammation and abnormal blood clotting, potentially contributing to adrenal tissue injury, infarction, or hemorrhage. The infection may also disrupt the hypothalamic-pituitary-adrenal axis, the comm
unication system connecting the brain with the adrenal glands.
The researchers cautioned that current evidence cannot determine how frequently this complication occurs or prove that COVID-19 directly caused every reported case.
The review was conducted by researchers from Astana Medical University in Astana, Kazakhstan, and West Kazakhstan Marat Ospanov Medical University in Aktobe, Kazakhstan.
Conclusion
The findings indicate that new adrenal insufficiency can occur in temporal association with COVID-19 and deserves clinical attention, particularly when unexplained low blood pressure, severe fatigue, low sodium, or shock develops. Larger prospective studies using standardized hormone testing are needed before routine screening of COVID-19 survivors can be recommended.
The study findings were published in the peer reviewed journal: Qatar Medical Journal.
https://www.qscience.com/view/journals/qmj/2026/2/article-35.xml
Read Also:
https://www.thailandmedical.news/articles/coronavirus
https://www.thailandmedical.news/articles/long-covid
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