Post-COVID-19 incidentally discovered adrenal findings (a CT-focused real-life study)

Coronavirus disease 2019 (COVID-19) pandemic was associated with unexpected endocrine findings at imaging evaluation, including adrenal incidentalomas.

To analyze adrenal findings at computed tomography (CT) in patients who underwent an abdominal and∕or thoracic CT scan for non-adrenal conditions and had a positive COVID-19 testing within six to 12 months before.

This was a retrospective, real-life study in adults.

Two groups [group C (positive COVID-19 infection; N=46 patients) vs. group non-C (prior negative infection; N=74 patients)] had similar age: 57.72±14.23 vs. 53.74±13.90 years (p=0.134). 73.33% of patients of group C had abnormal adrenal features similar to 66.22% of patients in non-C. Prevalence of adrenal nodules (ANs) was statistically significantly higher in group C (54.35%) vs. non-C (33.78%) (p=0.026). Detection rate of unilateral AN (45.65% vs. 25.67%; p=0.029) was also higher. 41.67% of entire group (N=120) displayed an AN (group AN), while 58.33% were nodule-free (group non-AN), with similar age and gender distribution. The number of patients with a history of COVID-19 infection was statistically significantly higher in group AN vs. non-AN (50% vs. 30%; p=0.026). Multivariate logistic regression analysis explained 17.5% of the variance (R²: 0.175). After adjusting for age, gender, right unilateral hyperplasia and left unilateral hyperplasia, the presence of the COVID-19 history remained statistically significantly (p=0.028) associated with increased odds of having an AN [odds ratio (OR: 2.471, 95% confidence interval (CI): 1.105-5.527]. A statistically significant correlation was found between the age and the largest diameter of AN within group AN (r=0.387, p=0.009).

Awareness remains the key factor in the CT-detected lesions that have been identified after prior coronavirus infection, some being a direct consequence, while others are incidental elements.