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The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis
OBJECTIVE: To study the adrenocortical response to an acute coronavirus disease-2019 (COVID-19) infection. METHODS: Morning plasma cortisol, adrenocorticotropic hormone (ACTH), and dehydroepiandrosterone sulfate levels were measured in 28 consecutive patients with COVID-19 (16 men, 12 women, median...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Association of Clinical Endocrinologists. Published by Elsevier Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837186/ https://www.ncbi.nlm.nih.gov/pubmed/33554871 http://dx.doi.org/10.1016/j.eprac.2020.10.014 |
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author | Alzahrani, Ali S. Mukhtar, Noha Aljomaiah, Abeer Aljamei, Hadeel Bakhsh, Abdulmohsen Alsudani, Nada Elsayed, Tarek Alrashidi, Nahlah Fadel, Roqayh Alqahtani, Eman Raef, Hussein Butt, Muhammad Imran Sulaiman, Othman |
author_facet | Alzahrani, Ali S. Mukhtar, Noha Aljomaiah, Abeer Aljamei, Hadeel Bakhsh, Abdulmohsen Alsudani, Nada Elsayed, Tarek Alrashidi, Nahlah Fadel, Roqayh Alqahtani, Eman Raef, Hussein Butt, Muhammad Imran Sulaiman, Othman |
author_sort | Alzahrani, Ali S. |
collection | PubMed |
description | OBJECTIVE: To study the adrenocortical response to an acute coronavirus disease-2019 (COVID-19) infection. METHODS: Morning plasma cortisol, adrenocorticotropic hormone (ACTH), and dehydroepiandrosterone sulfate levels were measured in 28 consecutive patients with COVID-19 (16 men, 12 women, median age 45.5 years, range 25-69 years) on day 1 to 2 of hospital admission. These tests were repeated twice in 20 patients and thrice in 15 patients on different days. The hormone levels were correlated with severity of the disease. RESULTS: The median morning cortisol level was 196 (31-587) nmol/L. It was <100 nmol/L in 8 patients (28.6%), <200 nmol/L in 14 patients (50%), and <300 nmol/L in 18 patients (64.3%). The corresponding ACTH values had a median of 18.5 ng/L (range 4-38 ng/L), and the ACTH level was <10 ng/L in 7 patients (26.9%), <20 ng/L in 17 patients (60.7%), and <30 ng/L in 23 patients (82.1%). The repeated testing on different days showed a similar pattern. Overall, if a cutoff level of <300 nmol/L is considered abnormal in the setting of acute disease, 9 patients (32%) had cortisol levels below this limit, regardless of whether the test was done only once (3 patients) or 3 times (6 patients). When the disease was more severe, the patients had lower cortisol and ACTH levels, suggesting a direct link between the COVID-19 infection and impaired glucocorticoid response. CONCLUSION: Unexpectedly, the adrenocortical response in patients with COVID-19 infection was impaired, and a significant percentage of the patients had plasma cortisol and ACTH levels consistent with central adrenal insufficiency. |
format | Online Article Text |
id | pubmed-7837186 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | American Association of Clinical Endocrinologists. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-78371862021-01-26 The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis Alzahrani, Ali S. Mukhtar, Noha Aljomaiah, Abeer Aljamei, Hadeel Bakhsh, Abdulmohsen Alsudani, Nada Elsayed, Tarek Alrashidi, Nahlah Fadel, Roqayh Alqahtani, Eman Raef, Hussein Butt, Muhammad Imran Sulaiman, Othman Endocr Pract Original Article OBJECTIVE: To study the adrenocortical response to an acute coronavirus disease-2019 (COVID-19) infection. METHODS: Morning plasma cortisol, adrenocorticotropic hormone (ACTH), and dehydroepiandrosterone sulfate levels were measured in 28 consecutive patients with COVID-19 (16 men, 12 women, median age 45.5 years, range 25-69 years) on day 1 to 2 of hospital admission. These tests were repeated twice in 20 patients and thrice in 15 patients on different days. The hormone levels were correlated with severity of the disease. RESULTS: The median morning cortisol level was 196 (31-587) nmol/L. It was <100 nmol/L in 8 patients (28.6%), <200 nmol/L in 14 patients (50%), and <300 nmol/L in 18 patients (64.3%). The corresponding ACTH values had a median of 18.5 ng/L (range 4-38 ng/L), and the ACTH level was <10 ng/L in 7 patients (26.9%), <20 ng/L in 17 patients (60.7%), and <30 ng/L in 23 patients (82.1%). The repeated testing on different days showed a similar pattern. Overall, if a cutoff level of <300 nmol/L is considered abnormal in the setting of acute disease, 9 patients (32%) had cortisol levels below this limit, regardless of whether the test was done only once (3 patients) or 3 times (6 patients). When the disease was more severe, the patients had lower cortisol and ACTH levels, suggesting a direct link between the COVID-19 infection and impaired glucocorticoid response. CONCLUSION: Unexpectedly, the adrenocortical response in patients with COVID-19 infection was impaired, and a significant percentage of the patients had plasma cortisol and ACTH levels consistent with central adrenal insufficiency. American Association of Clinical Endocrinologists. Published by Elsevier Inc. 2021-02 2020-12-28 /pmc/articles/PMC7837186/ /pubmed/33554871 http://dx.doi.org/10.1016/j.eprac.2020.10.014 Text en © 2020 American Association of Clinical Endocrinologists. Published by Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Original Article Alzahrani, Ali S. Mukhtar, Noha Aljomaiah, Abeer Aljamei, Hadeel Bakhsh, Abdulmohsen Alsudani, Nada Elsayed, Tarek Alrashidi, Nahlah Fadel, Roqayh Alqahtani, Eman Raef, Hussein Butt, Muhammad Imran Sulaiman, Othman The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis |
title | The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis |
title_full | The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis |
title_fullStr | The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis |
title_full_unstemmed | The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis |
title_short | The Impact of COVID-19 Viral Infection on the Hypothalamic-Pituitary-Adrenal Axis |
title_sort | impact of covid-19 viral infection on the hypothalamic-pituitary-adrenal axis |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837186/ https://www.ncbi.nlm.nih.gov/pubmed/33554871 http://dx.doi.org/10.1016/j.eprac.2020.10.014 |
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