Benign adrenal adenomas are associated with reduced prevalence of hospitalised patients with COVID‐19

Introduction

Adrenal incidentalomas (AI) are commonly found on imaging done for indications other than to assess the adrenal glands. Prevalence increases with age and is around 10% in people over 80 years. The majority of AIs are benign adenomas, with 20%−50% exhibiting mild autonomous cortisol secretion (MACS). Clinical guidelines recommend the use of dexamethasone to improve outcomes in patients with COVID-19 requiring oxygen.

Hypothesis

Benign adrenal adenomas protect against severe COVID-19.

Methods

Reports for all computed tomography pulmonary angiogram (CTPA) scans at Sheffield Teaching Hospitals between 11 March 2020 and 10 November 2021 were assessed for details of AI. Scan requests mandated recording COVID-19 status. Patients with a positive COVID-19 test within 2 weeks before the CTPA were classed as COVID-19 positive for the analyses. Duplicate scans were removed.

Results

A total of 4307 CTPA scans were included. The median age was 65 (IQR 49−77) and the majority of patients were female (55.0%). Seventy-six (1.76%) patients had a benign adenoma. COVID-19 positivity was found in 897 (20.8%). The presence of a benign adenoma was associated with a 70% reduced odds of being COVID-19 positive (aOR 0.30, 95% CI 0.12−0.74, p = 0.01), adjusting for age and sex.

Conclusion

Prevalence of adrenal adenoma was associated with significantly reduced odds of being SARS-CoV2 positive in an inpatient cohort. Secretion of mild excess cortisol (MACS) may be protective against developing severe COVID-19.