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Endocr J ; 69(11): 1335-1342, 2022 Nov 28.
Article in English | MEDLINE | ID: covidwho-2140769


Coronavirus disease 2019 (COVID-19) is associated with endocrine disorders, but their long-term clinical course remains unclear. We here report the 15-month clinical course for an individual with multiple endocrine disorders of the pituitary gland and testis likely triggered by COVID-19. A 65-year-old man with no history of endocrinopathy was admitted for acute COVID-19 pneumonia. Although his respiratory condition improved after administration of antiviral drugs, his blood pressure dropped suddenly to a preshock level and was refractory to vasopressors. The circulating adrenocorticotropic hormone (ACTH) and cortisol concentrations were low, and secondary adrenal insufficiency was suspected. Administration of hydrocortisone rapidly ameliorated the hypotension, and the patient was discharged taking 15 mg of hydrocortisone daily. An insulin tolerance test performed 3 months later revealed impaired ACTH, cortisol, and growth hormone (GH) responses, indicative of combined hypopituitarism. The patient also manifested symptoms of hypogonadism, and a hormonal workup suggested primary hypogonadism. At 12 months after discharge, GH and ACTH responses had recovered completely and partially, respectively. After another 3 months, basal ACTH and cortisol levels had been restored to the normal range and the patient discontinued hydrocortisone replacement without exacerbation of symptoms, although his hypogonadism persisted. The patient thus developed transient GH and ACTH deficiency that lasted for more than a year as well as persistent primary hypogonadism during intensive care for COVID-19. Certain prolonged symptoms of COVID-19 might be accounted for by such hormonal disturbance.

COVID-19 Drug Treatment , COVID-19 , Human Growth Hormone , Hypogonadism , Male , Humans , Aged , Adrenocorticotropic Hormone , Growth Hormone , Hydrocortisone/therapeutic use , COVID-19/complications , Human Growth Hormone/therapeutic use , Testosterone
Eur J Endocrinol ; 183(1): G17-G23, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-205229


Patients with pituitary tumours, ensuing hormonal abnormalities and mass effects are usually followed in multidisciplinary pituitary clinics and can represent a management challenge even during the times of non-pandemic. The COVID-19 pandemic has put on hold routine medical care for hundreds of millions of patients around the globe, while many pituitary patients' evaluations cannot be delayed for too long. Furthermore, the majority of patients with pituitary tumours have co-morbidities potentially impacting the course and management of COVID-19 (e.g. hypopituitarism, diabetes mellitus, hypertension, obesity and cardiovascular disease). Here, we summarize some of the diagnostic and management dilemmas encountered, and provide guidance on safe and as effective as possible delivery of care in the COVID-19 era. We also attempt to address how pituitary services should be remodelled in the event of similar crises, while maintaining or even improving patient outcomes. Regular review of these recommendations and further adjustments are needed, depending on the evolution of the COVID-19 pandemic status. We consider that the utilization of successful models of pituitary multidisciplinary care implemented during the COVID-19 pandemic should continue after the crisis is over by using the valuable and exceptional experience gained during these challenging times.

Adenoma/therapy , Antineoplastic Agents, Hormonal/therapeutic use , Coronavirus Infections , Dopamine Agonists/therapeutic use , Neurosurgical Procedures , Pandemics , Pituitary Apoplexy/therapy , Pituitary Neoplasms/therapy , Pneumonia, Viral , Adenoma/diagnosis , COVID-19 , Cabergoline/therapeutic use , Disease Management , Hormone Replacement Therapy , Human Growth Hormone/analogs & derivatives , Human Growth Hormone/therapeutic use , Humans , Octreotide/therapeutic use , Peptides, Cyclic/therapeutic use , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/diagnosis , Practice Guidelines as Topic , Radiotherapy , Somatostatin/analogs & derivatives , Somatostatin/therapeutic use , Telemedicine , Time Factors , Visual Field Tests