Are High Doses of Corticosteroids Protective in COVID-19 Patient With Panhypopituitarism?

Introduction: Clinical course of COVID-19 infection is diverse and the best therapeutical guidelines are still lacking. Case Presentation: We present a case of 73 year old male COVID-19 positive patient. In 2017 transnasal hypophysectomy was performed due to prolactinoma. He receives therapy (hydrocortisone 20 + 10 mg/day, levothyroxine 75/50 µg/day, bromocriptine 2.5 mg twice/day). He suffers also from arterial hypertension. Present illness started with intensive dry cough, fever (37.5(◦)C), diarrhoea and loss of smell. On the first day patient was febrile up to 38.4◦C and later afebrile. Laboratory parameters showed abnormalities in several parameters: D-dimers 13.45 (RR:< 0.50) mg/L, creatinine 110 (49-90) µmol/L, ALT 73 (12-28) U/L, LDH 531 (25-241) U/L, creatine kinase 549 (<177) U/L, GGT 277 (9-35) U/L, CRP 38 (<5 mg/L), sedimentation rate 40 (5-28) mm/3.6ks, procalcitonine 0.07 (<0.05) ng/ml, sodium 128 (137-146) mmol/L, hs-TroponinT 18 (< 14) ng/L, neutrophils 8.56 (2.06-6.49 x10(9)/L), lymphocytes 0.52 (1.19-3.35 x10(9)/L) and pO(2) 6.1 (11.0-14.4) kPa. At the admission X-ray showed normal presentation, while four days later on the right side pneumonia was noticed as spotty inhomogeneous shading. He was treated with azithromycin, hydrocortisone (50 mg twice/day) and oxygen supplementation. At the beginning of hospitalization he was addicted to O(2) 10-12 L/min. After 22 days of hospitalization he was discharged without any symptom but with still positive SARS-CoV2 swabs. After a 30 days of follow-up, his swabs are now negative with no laboratory abnormalities. In the meantime, his two brothers, born in 1945 and 1940 died due to COVID-19 infection. They did not receive substitutional corticosteroid therapy. Conclusion: The main pathophysiological mechanism of infection is explained by cytokine storm. Hypercytokinemia causes myelosuppression and vascular endothelium damage. Corticosteroids are potent anti-inflammatory agents. High-doses of corticosteroids might beneficially modulate the host immune response to SARS-CoV2 virus and have protective role in this patient.