Pathomorphology of the Adrenal Cortex Impairment in Covid-19

Abstract

This study investigates the structural changes and pathological alterations in the adrenal cortex of patients who succumbed to COVID-19. Findings indicate that the disease causes significant damage to the vascular and interstitial tissues of the adrenal gland, including fibrinoid swelling and necrosis in the walls of blood vessels, thrombosis within their lumens, perivascular hemorrhages, and infarcts and hemorrhages within the gland's parenchyma. Notably, the zona glomerulosa of the adrenal cortex is disrupted, and ischemia and hypoxia in the zona fasciculata lead to the formation of necrosis and infarction areas. The reticular area is predominantly affected by discirculatory changes, attributed to its high density of capillary blood vessels and a low number of parenchymatous cells. Additionally, the presence of lymphocytic infiltration around the gland's outer membrane and within the interstitial spaces suggests the initiation of an autoimmune response against the gland's parenchymatous cells, triggered by the damage to blood vessels and interstitial tissues caused by the SARS-CoV-2 virus.