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Four patients had an acute biological adrenal gland insufficiency (8%). Univariate analysis in AAI+ patients demonstrated a higher rate of ICU stay (67% vs. 45%, p 0.05) and a longer stay (more than 15 days for 31% for AAI+ vs. 19%, p 0.05) compared with AAI- patients. Mortality rate was similar (27%, p = 0.92). Acute adrenal infarction on initial chest evaluation of severe COVID-19 is frequent (51/219, 23%) and might be a sign of poorer prognosis. • Acute adrenal infarction on initial chest CT evaluation of severe COVID-19 i