Coronavirus disease 2019 (COVID-19) due to a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can include various systemic organ disorders including endocrinopathies and neurological manifestations. We report the case of a 65-year-old Japanese man who developed isolated adrenocorticotropic hormone (ACTH) deficiency and encephalopathy following SARS-CoV-2 infection. Two weeks after his COVID-19 diagnosis, he was emergently admitted to our hospital because of subacute-onset delirium. On admission, he presented hyponatremia (128 mEq/L) and secondary adrenal insufficiency (ACTH <1.5 pg/mL, cortisol 0.53 μg/dL). Brain imaging and laboratory examinations including SARS-CoV-2 polymerase chain reaction testing in the cerebrospinal fluid revealed no abnormalities. His consciousness level worsened despite the amelioration of hyponatremia by intravenous hydrocortisone (100 mg/day), but his neurological presentations completely resolved after three consecutive days of high-dose (400 mg/day) hydrocortisone. His encephalopathy did not deteriorate during hydrocortisone tapering. He continued 15 mg/day hydrocortisone after discharge. His encephalopathy might have developed via a disturbance of the autoimmune system, or a metabolic effect associated with adrenal insufficiency, although the time lag between the hyponatremia’s improvement and the patient’s neurological response to the steroid was incompatible with common cases of delirium concurrent with adrenal insufficiency. At 13 months after his hospitalization, the patient’s neurological symptoms have not recurred and he has no endocrinological dysfunctions other than the remaining ACTH deficiency. A thorough consideration of the immunological and metabolic characteristics of SARS-CoV-2 is advisable when clinicians treat patients during and even after their COVID-19 disease period.

由严重急性呼吸综合征冠状病毒-2 (SARS-CoV-2) 感染引起的 2019 冠状病毒病 (COVID-19) 可包括各种全身器官疾病，包括内分泌疾病和神经系统表现。我们报告了一名 65 岁日本男性在 SARS-CoV-2 感染后出现孤立性促肾上腺皮质激素 (ACTH) 缺乏症和脑病的病例。在诊断出 COVID-19 两周后，他因亚急性发作性谵妄被紧急送往我们医院。入院时，他出现低钠血症（128 mEq/L）和继发性肾上腺功能不全（ACTH <1.5 pg/mL，皮质醇 0.53 μg/dL）。脑成像和实验室检查（包括脑脊液中的 SARS-CoV-2 聚合酶链反应测试）未发现异常。尽管通过静脉注射氢化可的松（100毫克/天）改善了低钠血症，但他的意识水平仍然恶化，但在连续三天使用高剂量（400毫克/天）氢化可的松后，他的神经系统表现完全消失。在氢化可的松逐渐减量期间，他的脑病并未恶化。出院后，他继续每天服用 15 毫克氢化可的松。他的脑病可能是由于自身免疫系统紊乱或与肾上腺功能不全相关的代谢作用而发生的，尽管低钠血症的改善和患者对类固醇的神经系统反应之间的时间间隔与肾上腺功能不全并发谵妄的常见病例不相容。住院13个月后，患者的神经系统症状没有复发，除了残留的ACTH缺乏外，没有内分泌功能障碍。当临床医生在 COVID-19 疾病期间甚至之后治疗患者时，建议全面考虑 SARS-CoV-2 的免疫学和代谢特征。