ABSTRACT
Introduction: Coronavirus disease 2019 (COVID-19) mainly involves the lungs;it also affects the endocrine system including the hypothalamic-pituitary adrenal axis (HPA). Aims: To assess and compare the changes in the HPA axis in survivors of SARS CoV-2 infection 3 months after recovery. Methods: A cross-sectional, descriptive study was undertaken at JIPMER, including 69 patients 318 years of age, after 3 months after the diagnosis of COVID-19. At baseline, a fasting sample was collected for basal cortisol, thyroid function, and biochemical investigations between 8.00-9.00 AM. A low dose Synacthen test (1 mg) was performed in all patient's blood samples for serum cortisol collected after 30 and 60 minutes of intravenous administration. Results: The mean age (SD) was 49.74 ± 12.05 years, 24 (34.78%) were female and 45 (65.2%) were male patients. 20 (28.98%) patients had mild, 10 (14.4%) had moderate and 39 (56.52%) patients had severe COVID-19 infection. 62 (89.85%) patients had post covid symptoms. Out of the sixty-nine patients with COVID-19, nine patients (9/69, 13.04%) had peak serum cortisol <18 mg/dL suggestive of secondary adrenal insufficiency. Peak serum cortisol did not differ according to disease severity [Mild, (13.03 ± 4.08 mg/dL) vs moderate, [(11.52 ± 2.40 mg/dL) vs severe, (13.70 ± 1.43 mg/dL), P = 0.67]. In addition, there was no difference in peak serum cortisol in patients with or without adrenal insufficiency [(12.99 ± 2.54 mg/dL) vs (22.44±5.52 mg/dL), P = 0.09 respectively. Conclusion: HPA axis is affected in 13.04% of patients 3 months after presentation with COVID-19. These findings have important implications for the clinical care and long-term follow-up of patients after COVID-19.