Unmasking Adrenal Insufficiency in COVID-19: The Diagnostic Challenge of Concomitant Acute Kidney Injury and High Ileostomy Output

Ioanna I. Yglesias Dimadi; Afshan Hussain; Bronson Benno Joseph Raja

doi:10.12659/AJCR.952419

01 May 2026 : Case report USA

Unmasking Adrenal Insufficiency in COVID-19: The Diagnostic Challenge of Concomitant Acute Kidney Injury and High Ileostomy Output

Unusual clinical course, Challenging differential diagnosis

Ioanna I. Yglesias Dimadi

^{ABDEF 1*}, Afshan Hussain^{E 1}, Bronson Benno Joseph Raja

^{AE 1}

DOI: 10.12659/AJCR.952419

Am J Case Rep 2026; 27:e952419

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Figure 2 Timeline of the clinical course. The initial resolution of hyperkalemia (masking phase) was due to renal replacement therapy. Recurrence of hyperkalemia and shock despite renal recovery (unmasking phase) led to suspicion of adrenal insufficiency. Vertical line denotes initiation of hydrocortisone, which produced rapid clinical improvement. AKI – acute kidney injury.

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Unmasking Adrenal Insufficiency in COVID-19: The Diagnostic Challenge of Concomitant Acute Kidney Injury and High Ileostomy Output

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