Investigating the symptoms

Initially, the woman's 25-pound weight loss was attributed to a mild case of COVID-19. The woman, an ED physician, sought medical advice after failing to find an obvious cause.

Despite no changes in diet or lifestyle, the patient expressed concern about her sudden weight loss, being especially cautious after a friend's similar unintentional weight loss led to a cancer diagnosis.

Her ob/gyn found no health issues, and a recent colonoscopy and mammogram were both normal. Still, she visited her primary care physician Jame Rommer to see what he thought of her unintended weight loss.

Although the patient's blood pressure was elevated during the exam — something she was already taking medication for —everything else was normal. However, Rommer agreed that the weight loss was concerning and ordered several lab tests, including for blood count, chemistries, liver, and thyroid studies. He also planned to see if she had any unusual tumors that could be increasing her blood pressure through excessive cortisol or epinephrine.

A life-threatening deficiency

The next morning, while at the gym, the patient received a call from Rommer with an urgent concern — her cortisol levels, expected to be normal or high due to suspected potential tumors, were instead "practically undetectable," Sanders writes.

Nevin remained baffled. Unlike other patients with adrenal insufficiency, the woman was not tired or listless, did not have weak or painful muscles, or have blood pressure so low that she could not stand up.

Given the uncertainty, the patient started hydrocortisone treatment and gradually regained weight. Unexpectedly, her high blood pressure improved, allowing her to discontinue her hypertension medications.

While searching for explanations, Nevin found a few case reports linking COVID-19 to adrenal insufficiency. A later study revealed that "14 percent of people with COVID-19 developed adrenal insufficiency that often improved on its own over time," Sanders writes.

The patient continues to take a low dose of hydrocortisone but hopes to discontinue it. While there's no way to know for certain if COVID-19 caused the patient's adrenal insufficiency, she and Nevin plan a gradual medication withdrawal to test for recovery.