Hyporeninemic hypoaldosteronism as a manifestation of autonomic neuropathy in a patient with type 2 diabetes mellitus against the background of coronavirus disease. A clinical case

Abstract

Coronavirus disease (COVID-19) is often associated with endocrine complications. The article describes a clinical case of the patient with type 2 diabetes mellitus and COVID-19 after which, for the first time, there was a need for basal-bolus insulin therapy, and secondly, a significant arterial hypotension occurred. The mechanism of damage to β-cells of the pancreas in the patient is debatable. After analyzing the features of diabetes course, we found an acute onset of the disease at the age of 44 years with pronounced hyperglycemia and ketosis, which required insulin therapy. Then for a long time there was no need in insulin therapy, and the patient took metformin, having overweight, no antibodies to β-cell antigens. It is also impossible to exclude the effect of SARS-CoV-2 on the secretory function of β-cells of the pancreas. Accordingly, clinical cases are interesting, as their analysis helps to understand not only the mechanism of development and progression of this infection, but also the diagnosis and treatment of its complications. We have described a rare clinical case of the hyporeninemic hypoaldosteronism in the patient with type 2 diabetes mellitus after COVID-19 infection. Afeature of the hyporeninemic hypoaldosteronism course was the absence of electrolyte disorders in the patient, with severe arterial hypotension, suppression of renin and aldosterone. We believe that the hyporeninemic hypoaldosteronism has been associated with the progression of chronic diabetes complications, mainly autonomic neuropathy against the background of COVID-19. To improve the identified disorders, replacement therapy with mineralocorticoids was prescribed. The blood pressure, symptoms of fluid retention and electrolyte levels were monitored when selecting the dose of fludrocortisone. The patient has been under observation for 14 months, the need for fludrocortisone replacement therapy persists to this day. Practicing doctors need to pay attention to the diagnosis of autonomic disorders, which reduce the patients’ quality of life and are an independent risk factor for cardiovascular mortality.