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2.
Internist (Berl) ; 63(1): 4-11, 2022 Jan.
Article in German | MEDLINE | ID: covidwho-1635233

ABSTRACT

Diseases of the adrenal cortex require particular attention during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Firstly, SARS-CoV­2 infections can give rise to extrapulmonary manifestations and cause endocrine disorders, particularly in the adrenal cortex. Furthermore, patients with pre-existing insufficiency of the adrenal cortex or hypercortisonism are particularly at risk from a severe infection such as SARS-CoV­2, to suffer from additional complications or a more severe course of a SARS-CoV­2 infection with a higher mortality. Especially in hemodynamically unstable patients with a SARS-CoV­2 infection, diseases of the adrenal glands should also be considered in the differential diagnostics and if necessary clarified, if this is not already known. Prolonged treatment of patients with a SARS-CoV­2 infection with regimens containing high doses of glucocorticoids can also result in a secondary adrenal insufficiency. In order to address these special aspects, some practical recommendations for the diagnostic and therapeutic management of functional disorders of the adrenal glands in patients with a SARS-CoV­2 infection are therefore presented.


Subject(s)
Adrenal Cortex , Adrenal Insufficiency , COVID-19 , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/drug therapy , Humans , Pandemics , SARS-CoV-2
4.
Front Endocrinol (Lausanne) ; 12: 705214, 2021.
Article in English | MEDLINE | ID: covidwho-1448725

ABSTRACT

The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a global health crisis affecting millions of people worldwide. SARS-CoV-2 enters the host cells by binding to angiotensin-converting enzyme 2 (ACE2) after being cleaved by the transmembrane protease serine 2 (TMPRSS2). In addition to the lung, gastrointestinal tract and kidney, ACE2 is also extensively expressed in endocrine tissues, including the pituitary and adrenal glands. Although glucocorticoids could play a central role as immunosuppressants during the cytokine storm, they can have both stimulating and inhibitory effects on immune response, depending on the timing of their administration and their circulating levels. Patients with adrenal insufficiency (AI) or Cushing's syndrome (CS) are therefore vulnerable groups in relation to COVID-19. Additionally, patients with adrenocortical carcinoma (ACC) could also be more vulnerable to COVID-19 due to the immunosuppressive state caused by the cancer itself, by secreted glucocorticoids, and by anticancer treatments. This review comprehensively summarizes the current literature on susceptibility to and outcome of COVID-19 in AI, CS and ACC patients and emphasizes potential pathophysiological mechanisms of susceptibility to COVID-19 as well as the management of these patients in case of SARS-CoV-2. Finally, by performing an in silico analysis, we describe the mRNA expression of ACE2, TMPRSS2 and the genes encoding their co-receptors CTSB, CTSL and FURIN in normal adrenal and adrenocortical tumors (both adenomas and carcinomas).


Subject(s)
COVID-19/complications , COVID-19/virology , Glucocorticoids/administration & dosage , Adrenal Insufficiency/complications , Adrenal Insufficiency/immunology , Angiotensin-Converting Enzyme 2/genetics , Angiotensin-Converting Enzyme 2/immunology , Animals , COVID-19/genetics , COVID-19/immunology , Cushing Syndrome/complications , Cushing Syndrome/immunology , Humans , Neoplasms/complications , Neoplasms/immunology , SARS-CoV-2/genetics , SARS-CoV-2/physiology
5.
BMJ Case Rep ; 14(8)2021 Aug 05.
Article in English | MEDLINE | ID: covidwho-1346042

ABSTRACT

A 40-year-old woman presented to our emergency department in an altered state following a generalised tonic-clonic seizure. On regaining consciousness, she gave a history of bleeding tendencies and menorrhagia, fatigue, nausea, vomiting and appetite loss for a long time. She had received multiple blood transfusions in the last 10 years. Investigations revealed severe hyponatraemia, transaminitis and pancytopenia, which showed cyclical fluctuations in the hospital. Hyponatraemia was attributed to a central cause owing to secondary hypothyroidism and hypocortisolism on evaluation. A diagnosis of cyclical thrombocytopenia was made by logging the trends of blood cell lines and applying the Lomb-Scargle test. Liver biopsy showed features of transfusion hemosiderosis explaining transaminitis. All of the haematological abnormalities and clinical symptoms resolved on thyroxine and corticosteroid replacement, suggesting causal association hypopituitarism with cyclical thrombocytopenia.


Subject(s)
Adrenal Insufficiency , Hyponatremia , Hypopituitarism , Pancytopenia , Adult , Female , Humans , Hyponatremia/diagnosis , Hyponatremia/etiology , Hypopituitarism/complications , Hypopituitarism/diagnosis , Hypopituitarism/drug therapy , Seizures
6.
Minerva Endocrinol (Torino) ; 47(1): 117-126, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1326107

ABSTRACT

The Coronavirus-19 (COVID-19) pandemic, which began in December 2019 in Wuhan, China, has spread rapidly worldwide, affecting mostly frail individuals and resulting in high lethality among people with chronic conditions. The management of chronic endocrine disorders during the pandemic period proved particularly challenging, as they require close physician-patient contact for proper long-term management. In addition, acute endocrinologic conditions that presented during the COVID-19 period required timely management in an unusual clinical setting, providing an ongoing challenge for clinicians. This article summarizes the most recent guidance on the management and therapy of frequent conditions such as diabetes and osteoporosis and less common endocrine disorders (e.g., adrenal insufficiency) in this setting.


Subject(s)
Adrenal Insufficiency , COVID-19 , Diabetes Mellitus , Diabetes Mellitus/epidemiology , Humans , Pandemics , SARS-CoV-2
7.
J Clin Endocrinol Metab ; 106(7): e2469-e2479, 2021 06 16.
Article in English | MEDLINE | ID: covidwho-1247625

ABSTRACT

CONTEXT: The COVID-19 pandemic has impacted healthcare environment. OBJECTIVE: To determine the impact of the pandemic on self-reported outcomes in patients with adrenal insufficiency (AI). DESIGN AND SETTING: Prospective longitudinal survey study at 2 tertiary centers. PARTICIPANTS: Patients with AI. INTERVENTION: Patient-centered questionnaire. MAIN OUTCOME MEASURES: Depression Anxiety Stress Scales-21, Short Form-36, and AI self-management. RESULTS: Of 342 patients, 157 (46%) had primary AI, 109 (32%) had secondary AI, and 76 (22%) had glucocorticoid-induced AI. When compared to prepandemic, daily glucocorticoid dose and number of adrenal crises did not change. However, patients reported a higher financial impact from AI (34% vs 23%, P = 0.006) and difficulty accessing medical care (31% vs 7%, P < 0.0001) during the pandemic. A third of patients reported difficulty managing AI during the pandemic. After adjusting for duration and subtypes of AI, younger patients [odds ratio (OR) 2.3, CI 95% 1.3-4.1], women (OR 3.7, CI 95% 1.9-7.1), poor healthcare access(OR 4.2, CI 95% 2.3-7.7), lack of good insurance support (OR 2.8, CI 95% 1.3-5.9), and those with a higher financial impact (OR 2.3, CI 95% 1.3-4.3) reported greater difficulties managing AI. Patients were more likely to report a higher anxiety score (≥8) if they found managing AI challenging during the pandemic (OR 3.0, CI 95% 1.3-6.9), and had lower Physical Component Summary (OR 4.9, CI 95% 2.2-11.0) and Mental Component Summary (OR 4.1, CI 95% 1.8-9.5) scores prior to the pandemic. CONCLUSIONS: A third of patients with AI reported difficulties with management of AI during the pandemic, particularly in younger patients, women, and those with poor healthcare access.


Subject(s)
Adrenal Insufficiency/drug therapy , Anxiety/epidemiology , COVID-19/prevention & control , Patient Reported Outcome Measures , Self-Management/statistics & numerical data , Adrenal Insufficiency/economics , Adrenal Insufficiency/psychology , Age Factors , Aged , Anxiety/diagnosis , Anxiety/etiology , Anxiety/psychology , COVID-19/economics , COVID-19/epidemiology , COVID-19/psychology , Communicable Disease Control/standards , Female , Financial Stress/diagnosis , Financial Stress/epidemiology , Financial Stress/psychology , Glucocorticoids/administration & dosage , Glucocorticoids/economics , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Humans , Longitudinal Studies , Male , Middle Aged , Pandemics/economics , Pandemics/prevention & control , Patient Health Questionnaire/statistics & numerical data , Prevalence , Prospective Studies , Quality of Life , Risk Factors , Self Report/statistics & numerical data , Self-Management/economics , Sex Factors , United States/epidemiology
8.
Endocrine ; 71(3): 586-594, 2021 03.
Article in English | MEDLINE | ID: covidwho-1233294

ABSTRACT

Adrenal insufficiency (AI) is a life-threatening condition requiring life-long glucocorticoid (GC) substitution therapy, as well as stress adaptation to prevent adrenal crises. The number of individuals with primary and secondary adrenal insufficiency in Europe is estimated to be 20-50/100.000. A growing number of AI cases are due to side effects of GC treatment used in different treatment strategies for cancer and to immunotherapy in cancer treatment. The benefit of hormone replacement therapy is evident but long-term adverse effects may arise due to the non-physiological GC doses and treatment regimens used. Given multiple GC replacement formulations available comprising short-acting, intermediate, long-acting and novel modified-release hydrocortisone as well as subcutaneous formulations, this review offers a concise summary on the latest therapeutic improvements for treatment of AI and prevention of adrenal crises. As availability of various glucocorticoid formulations and access to expert centers across Europe varies widely, European Reference Networks on rare endocrine conditions aim at harmonizing treatment and ensure access to specialized patient care for individual case-by-case treatment decisions. To improve the availability across Europe to cost effective oral and parenteral formulations of hydrocortisone will save lives.


Subject(s)
Adrenal Insufficiency , Adrenal Insufficiency/drug therapy , Europe , Glucocorticoids/therapeutic use , Hormone Replacement Therapy , Humans , Hydrocortisone/therapeutic use
10.
Pan Afr Med J ; 38: 222, 2021.
Article in English | MEDLINE | ID: covidwho-1175755

ABSTRACT

SARS-CoV-2 infection, responsible for the coronavirus disease-2019 (COVID-19) has rapidly spread, causing a global pandemic. COVID-19 can affect any organ system in the body due to overwhelming dysregulated immune response and long-term effects of the disease is still unknown. Endocrine complications associated with COVID-19 is exceedingly rare. Here we present a unique case of a 44-year-old female who developed adrenal insufficiency and central diabetes insipidus following COVID-19 infection.


Subject(s)
Adrenal Insufficiency/diagnosis , COVID-19/complications , Diabetes Insipidus/diagnosis , Adrenal Insufficiency/virology , Adult , Diabetes Insipidus/virology , Female , Humans
11.
Am J Physiol Endocrinol Metab ; 320(4): E784-E785, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1171039
12.
Nat Rev Dis Primers ; 7(1): 19, 2021 03 11.
Article in English | MEDLINE | ID: covidwho-1139741

ABSTRACT

Adrenal insufficiency (AI) is a condition characterized by an absolute or relative deficiency of adrenal cortisol production. Primary AI (PAI) is rare and is caused by direct adrenal failure. Secondary AI (SAI) is more frequent and is caused by diseases affecting the pituitary, whereas in tertiary AI (TAI), the hypothalamus is affected. The most prevalent form is TAI owing to exogenous glucocorticoid use. Symptoms of AI are non-specific, often overlooked or misdiagnosed, and are related to the lack of cortisol, adrenal androgen precursors and aldosterone (especially in PAI). Diagnosis is based on measurement of the adrenal corticosteroid hormones, their regulatory peptide hormones and stimulation tests. The goal of therapy is to establish a hormone replacement regimen that closely mimics the physiological diurnal cortisol secretion pattern, tailored to the patient's daily needs. This Primer provides insights into the epidemiology, mechanisms and management of AI during pregnancy as well as challenges of long-term management. In addition, the importance of identifying life-threatening adrenal emergencies (acute AI and adrenal crisis) is highlighted and strategies for prevention, which include patient education, glucocorticoid emergency cards and injection kits, are described.


Subject(s)
Adrenal Insufficiency , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/drug therapy , Adrenal Insufficiency/epidemiology , Glucocorticoids/therapeutic use , Hormone Replacement Therapy , Humans
13.
J Clin Endocrinol Metab ; 106(3): e1354-e1361, 2021 03 08.
Article in English | MEDLINE | ID: covidwho-1127737

ABSTRACT

CONTEXT: Coronavirus disease 2019 (COVID-19) represents a global health emergency, and infected patients with chronic diseases often present with a severe impairment. Adrenal insufficiency (AI) is supposed to be associated with an increased infection risk, which could trigger an adrenal crisis. OBJECTIVE: Our primary aim was to evaluate the incidence of COVID-19 symptoms and complications in AI patients. DESIGN AND SETTING: We conducted a retrospective case-control study. All patients were on active follow-up and lived in Lombardy, Italy, one of the most affected areas. PATIENTS: We enrolled 279 patients with primary and secondary AI and 112 controls (patients with benign pituitary lesions without hormonal alterations). All AI patients had been previously trained to modify their replacement therapy on stress doses. INTERVENTION: By administering a standardized questionnaire by phone, we collected data on COVID-19 suggestive symptoms and consequences. RESULTS: In February through April 2020, the prevalence of symptomatic patients (complaining at least 1 symptom of viral infection) was similar between the 2 groups (24% in AI and 22.3% in controls, P = 0.79). Highly suggestive COVID-19 symptoms (at least 2 including fever and/or cough) also occurred equally in AI and controls (12.5% in both groups). No patient required hospitalization and no adrenal crisis was reported. Few nasopharyngeal swabs were performed (n = 12), as indicated by sanitary regulations, limiting conclusions on the exact infection rate (2 positive results in AI and none in controls, P = 0.52). CONCLUSIONS: AI patients who are adequately treated and trained seem to display the same incidence of COVID-19-suggestive symptoms and disease severity as controls.


Subject(s)
Adrenal Insufficiency/complications , COVID-19/epidemiology , Adrenal Insufficiency/drug therapy , Adrenal Insufficiency/immunology , Adult , Aged , COVID-19/diagnosis , COVID-19/immunology , Case-Control Studies , Cortisone/administration & dosage , Female , Humans , Hydrocortisone/administration & dosage , Incidence , Italy/epidemiology , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Severity of Illness Index , Tertiary Care Centers/statistics & numerical data
14.
Endocrinol Diabetes Metab ; 4(3): e00246, 2021 07.
Article in English | MEDLINE | ID: covidwho-1122029

ABSTRACT

Introduction: The coronavirus disease 2019 (COVID-19) is currently a major pandemic challenge, and cancer patients are at a heightened risk of severity and mortality from this infection. In recent years, immune checkpoint inhibitor (ICI) use to treat multiple cancers has increased in oncology, but equally has raised the question of whether ICI therapy and its side-effects is harmful or beneficial during this pandemic. Methods: A combination of published literature in PubMed between January 2010 and December 2020, recommended guidelines in non-cancer patients, and clinical experience was utilized to outline recommendations on glucocorticoid timing and dosing regimens in ICI-treated patients presenting with AI during this COVID-19 pandemic. Results: The potential immune interaction between ICIs and COVID-19 require major consideration because these agents act at the intersection between effective cancer immunotherapy and increasing patient susceptibility, severity and complications from the SARS-CoV-2 sepsis. Furthermore, ICI use can induce autoimmune adrenal insufficiency (AI) that further increases infection susceptibility. Thus, ICI-treated cancer patients with AI may be at greater risk of COVID-19 infection. Glucocorticoids are the cornerstone for replacement therapy, and for treatment and mitigation of adrenal crisis and relief of mass effects in ICI-related hypophysitis. High-dose glucocorticoids have also been used with cytotoxic chemotherapy as part of cancer treatment, and iatrogenic AI may arise after glucocorticoid discontinuation that increases the risk of adrenal crisis. Furthermore, in patients who develop the "long COVID-19" syndrome, when to discontinue glucocorticoid therapy becomes crucial to avoid unnecessary prolongation of therapy and the development of iatrogenic hypercortisolemia. Conclusion: During the COVID-19 pandemic, much of cancer care have been impacted and an important clinical question is how to optimally manage ICI-related AI during these unprecedented times. Herein, we suggest practical recommendations on the timing and dosing regimens of glucocorticoids in different clinical scenarios of ICI-treated cancer patients presenting with AI during this COVID-19 pandemic.


Subject(s)
Adrenal Insufficiency/drug therapy , COVID-19 , Immune Checkpoint Inhibitors/adverse effects , Neoplasms/drug therapy , Adrenal Insufficiency/chemically induced , Humans , Immune Checkpoint Inhibitors/therapeutic use , Pandemics
15.
Eur J Clin Invest ; 50(7): e13262, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1081113

ABSTRACT

The Covid-19 pandemic confronted us with unknown clinical pictures, also in diabetology and endocrinology. Sharing clinical experiences is therefore of enormous importance. Actually, information about the care given in the Covid-19 ward (in contrast to that provided in the Emergency Room/ICU) is still sparse. The last weeks we built experience and gathered knowledge while giving hospital care to patients who had a pre-existent endocrine disease (and diabetes; most patients suffered from a type two diabetes). In our contribution we presented our insights obtained from this intensive period obtained in the Covid-19 ward.


Subject(s)
Coronavirus Infections/therapy , Diabetes Mellitus, Type 2/drug therapy , Hyperglycemia/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Pneumonia, Viral/therapy , Adrenal Insufficiency/complications , Adrenal Insufficiency/drug therapy , Belgium , Betacoronavirus , Blood Glucose/metabolism , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/metabolism , Diabetes Complications , Diabetes Insipidus/complications , Diabetes Insipidus/therapy , Diabetes Mellitus/drug therapy , Diabetes Mellitus/metabolism , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/metabolism , Disease Management , Glycated Hemoglobin A/metabolism , Hospital Units , Hospitalization , Humans , Hyperglycemia/etiology , Hyperglycemia/metabolism , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/metabolism , SARS-CoV-2
16.
Pituitary ; 24(2): 143-145, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1074463

ABSTRACT

PURPOSE: Side effects of the coronavirus disease 2019 (COVID-19) vaccines include pain at the injection site, fatigue, headache, myalgias, arthralgias, chills, and fever, all of which can be early indicators of an increased need for glucocorticoid replacement in patients with adrenal insufficiency. The Pituitary Society surveyed its membership to understand planned approaches to glucocorticoid management in patients with adrenal insufficiency who will receive a COVID-19 vaccine. METHODS: Members were asked to complete up to 3 questions regarding their planned approach for use of glucocorticoid replacement in patients with proven adrenal insufficiency. RESULTS: Surveys were sent to 273 members and 103 responded. Thirty-six percent plan to recommend that patients automatically increase glucocorticoid dosage with administration of the first vaccine injection. Of these, 84% plan to increase glucocorticoid dose on the day of vaccination, and 49% plan to increase glucocorticoid dose prior to vaccination. Of the 64% who do not plan to recommend automatic glucocorticoid dose increase with vaccine administration, 88% plan to increase the dose if the patient develops a fever, and 47% plan to increase the dose if myalgias and arthralgias occur. CONCLUSIONS: Most clinicians plan to maintain the current glucocorticoid dose with vaccine administration. The vast majority plan and to increase glucocorticoid dose in case of fever, and just under half in case of arthralgias and myalgias. These survey results offer suggested management guidance for glucocorticoid management in patients with adrenal insufficiency.


Subject(s)
Adrenal Insufficiency/drug therapy , COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Glucocorticoids/therapeutic use , Adrenal Insufficiency/epidemiology , Adrenal Insufficiency/pathology , COVID-19/epidemiology , COVID-19/immunology , COVID-19 Vaccines/adverse effects , Dexamethasone/adverse effects , Dexamethasone/therapeutic use , Endocrinology/organization & administration , Endocrinology/standards , Humans , Hypothalamo-Hypophyseal System/drug effects , Pandemics , Pituitary Diseases/therapy , Pituitary-Adrenal System/drug effects , Practice Patterns, Physicians'/standards , SARS-CoV-2/immunology , Societies, Medical , Surveys and Questionnaires
18.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066835

ABSTRACT

SARS-CoV-2 is the cause of COVID-19. Since the outbreak and rapid spread of COVID-19, it has been apparent that the disease is having multi-organ system involvement. Still its effect in the endocrine system is not fully clear and data on cortisol dynamics in patients with COVID-19 are not yet available. SARS-CoV-2 can knock down the host's cortisol stress response. Here we present a case of a 51-year-old man vomiting for 10 days after having confirmed COVID-19 infection. He had hypotension and significant hyponatraemia. Work-up was done including adrenocorticotropic hormone stimulation test. He was diagnosed as suffering from adrenal insufficiency and started on steroids with subsequent improvement in both blood pressure and sodium level. COVID-19 can cause adrenal insufficiency. Clinicians must be vigilant about the possibility of an underlying relative cortisol deficiency in patients with COVID-19.


Subject(s)
Adrenal Insufficiency/physiopathology , COVID-19/physiopathology , Hyponatremia/physiopathology , Hypotension/physiopathology , Acidosis/blood , Acidosis/physiopathology , Acidosis/therapy , Adrenal Insufficiency/blood , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/drug therapy , COVID-19/blood , Fluid Therapy , Glucocorticoids/therapeutic use , Humans , Hydrocortisone/blood , Hyponatremia/blood , Hyponatremia/therapy , Hypophosphatemia/blood , Hypophosphatemia/physiopathology , Hypophosphatemia/therapy , Hypotension/therapy , Male , Middle Aged , Pituitary-Adrenal Function Tests , Prednisolone/therapeutic use , SARS-CoV-2 , Vomiting/physiopathology , Water-Electrolyte Imbalance/blood , Water-Electrolyte Imbalance/physiopathology , Water-Electrolyte Imbalance/therapy
19.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub ; 165(1): 1-7, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1067888

ABSTRACT

The current Coronavirus disease outbreak requires that physicians work in collaboration with other physicians especially in intensive care and emergency units. To fight against this new disease, whose pathogenesis, effects, and results have not been clearly demonstrated, especially in patients with the pre-existing chronic disease, requires special expertise and perspectives. Due to the need for dynamic glucocorticoid treatment at different stages of the disease in patients with adrenal insufficiency, the existence of reports indicating that "coronavirus disease 2019" also affects the adrenal reserve, and the use of glucocorticoids also in advanced stages in patients with Coronavirus disease require this issue to be emphasized with precision. Herein, treatment of the pre-existing adrenal insufficiency in patients with actual Coronavirus disease and the effects of the this critical disease on the adrenal gland have been reviewed.


Subject(s)
Adrenal Insufficiency/drug therapy , COVID-19/therapy , Glucocorticoids/therapeutic use , Hydrocortisone/therapeutic use , Adrenal Glands/metabolism , Adrenal Insufficiency/complications , Adrenal Insufficiency/metabolism , COVID-19/complications , Disease Management , Disease Progression , Hormone Replacement Therapy/methods , Hospitalization , Humans , Inflammation , SARS-CoV-2 , Stress, Physiological
20.
Front Endocrinol (Lausanne) ; 11: 593179, 2020.
Article in English | MEDLINE | ID: covidwho-1045524

ABSTRACT

Background: The majority of the critically ill patients may have critical illness-related corticosteroid insufficiency (CIRCI). The therapeutic effect of dexamethasone may be related to its ability to improve cortical function. Recent study showed that dexamethasone can reduce COVID-19 deaths by up to one third in critically ill patients. The aim of this article is to investigate whether SARS-CoV-2 can attack the adrenal cortex to aggravate the relative adrenal insufficiency. Methods: We summarized the clinical features of COVID-19 reported in currently available observational studies. ACE2 and TMPRSS2 expression was examined in human adrenal glands by immunohistochemical staining. We retrospectively analyzed serum cortisol levels in critically ill patients with or without COVID-19. Results: High percentage of critically ill patients with SARS-COV-2 infection in the study were treated with vasopressors. ACE2 receptor and TMPRSS2 serine protease were colocalized in adrenocortical cells in zona fasciculata and zona reticularis. We collected plasma cortisol concentrations in nine critically ill patients with COVID-19. The cortisol levels of critically ill patients with COVID-19 were lower than those in non-COVID-19 critically ill group. Six of the nine COVID-19 critically ill patients had random plasma cortisol concentrations below 10 µg/dl, which met the criteria for the diagnosis of CIRCI. Conclusion: We demonstrate that ACE2 and TMPRSS2 are colocalized in adrenocortical cells, and that the cortisol levels are lower in critically ill patients with COVID-19 as compared to those of non-COVID-19 critically ill patients. Based on our findings, we recommend measuring plasma cortisol level to guide hormonal therapy.


Subject(s)
Adrenal Cortex Diseases/drug therapy , Adrenal Cortex Diseases/virology , Adrenal Cortex/virology , COVID-19/virology , Adrenal Cortex/enzymology , Adrenal Insufficiency/etiology , Adrenal Insufficiency/therapy , Adult , Aged , Aged, 80 and over , Angiotensin-Converting Enzyme 2/metabolism , COVID-19/drug therapy , Critical Illness , Dexamethasone/therapeutic use , Female , Humans , Hydrocortisone/blood , Male , Middle Aged , Serine Endopeptidases/metabolism , Vasoconstrictor Agents/therapeutic use , Zona Fasciculata/metabolism , Zona Reticularis/metabolism
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