Changes in Physiological Levels of Cortisol and Adrenocorticotropic Hormone upon Hospitalization Can Predict SARS-CoV-2 Mortality: A Cohort Study

Ahmadi, Iraj; Babaki, Hamideh Estabraghnia; Maleki, Maryam; Jarineshin, Hashem; Kaffashian, Mohammad Reza; Hassaniazad, Mehdi; Kenarkoohi, Azra; Ghanbarnejad, Amin; Falahi, Shahab; Jahromi, Mitra Kazemi; Ghaneialvar, Hori; Sohrabipour, Shahla

doi:10.1155/2022/4280691

Cited by 27 publications

(34 citation statements)

References 32 publications

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“…A recent metaanalysis of published data revealed significantly higher levels of cortisol in patients with severe COVID-19 in comparison with those with mild-to-moderate disease forms [59] . However, cortisol levels were substantially lower in fatal cases of COVID-19 compared to survivors [60] . The apparent contradiction in some of these results might be explained by the heterogeneity of patient samples as well as testing protocols used.…”

Section: Pituitary Pathology In the Context Of Covid-19mentioning

confidence: 82%

Pituitary and SARS CoV-2: An unremitting conundrum

Căpățînă

Poiană

Fleseriu

2023

Best Practice & Research Clinical Endocrinology & Metab

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Section: Pituitary Pathology In the Context Of Covid-19mentioning

confidence: 82%

Pituitary and SARS CoV-2: An unremitting conundrum

Căpățînă

Poiană

Fleseriu

2023

Best Practice & Research Clinical Endocrinology & Metab

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“…Among them, 32 % (9/28) of patients had central adrenal insufficiency and fulfilled the criteria of CIRCI ( < 10.8 μg/dl) [62]. Similarly, in another study with a larger number of COVID-19 patients (n = 154), significantly lower cortisol but not ACTH plasma levels were found among non-survivors [63]. Finally, adrenal hypocortisolism (cortisol < 15 μg/dl in moderate-to-severe group vs. < 6 μg/dl in mild group), was more frequently found (38.5 vs. 6.8 %) in patients with severe COVID-19 (n = 35) as compared to patients with mild disease group (n = 49) [64].…”

Section: Adrenal Gland Function In Patients With Covid-19mentioning

confidence: 85%

Adrenal Gland Function and Dysfunction During COVID-19

et al. 2022

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The coronavirus disease 2019 (COVID-19) pandemic is currently one of the major health concerns worldwide accounting for many deaths and posing a great social and economic burden. Early activation of adrenal hormone secretion is pivotal to surviving systemic microbial infections. In addition, clinical studies demonstrated that glucocorticoids might also be beneficial in reducing disease progression and life deterioration in certain patients with COVID-19. Recent studies demonstrated that SARS-CoV-2 might target the adrenal glands, raising the possibility that at least some COVID-19 complications may be associated with adrenal dysfunction. Whether SARS-CoV-2 infection might cause adrenal dysfunction remains unknown. Histopathological examinations provided evidence that SARS-CoV-2 infection might indeed cause certain structural damage to the adrenal glands, especially concerning its vascular system. However, since no widespread cellular damage to cortical cells was observed, it is less likely that those changes could lead to an immediate adrenal crisis. This assumption is supported by the limited number of studies reporting rather adequate cortisol levels in patients with acute COVID-19. Those studies, however, could not exclude a potential late-onset or milder form of adrenal insufficiency. Although structural damage to adrenal glands is a rarely reported complication of COVID-19, some patients might develop a critical illness-related corticosteroid insufficiency (CIRCI), or iatrogenic adrenal insufficiency resulting from prolonged treatment with synthetic glucocorticoids. In this mini-review article, we aimed at describing and discussing factors involved in the adrenal gland function and possible dysfunction during COVID-19.

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“…Cortisol levels were substantially lower in those who died (311.7 (273.1-394.5) nmol/L) than in patients who were discharged (460.7 (344.8-598.6) nmol/L) (p = 0.003), while ACTH levels were unaffected. According to the logistic model, cortisol levels that rose by one unit correlated with a 26% lower mortality risk [66]. Overall, the existing evidence does not consistently support an association of severe COVID-19 with the presence of reduced or increased cortisol.…”

Section: Clinical Data During Acute Covid-19 Infectionmentioning

confidence: 86%

“…By contrast, the most recent findings revealed that individuals with SARS-CoV-2 who had lower cortisol levels had a greater fatality rate [66]. A total of 154 hospitalized patients with COVID-19 were studied in a prospective cohort study.…”

Section: Clinical Data During Acute Covid-19 Infectionmentioning

confidence: 97%

“…Beyond the above hypotheses, there are limited clinical data on HPA axis deregulation in COVID-19 patients during an acute infection. One limitation is the difficulty of performing a complete and exact evaluation of the HPA axis in patients with COVID-19 who are glucocorticoid dependent [66]. AI is a disease that is probably unrecognized in clinical settings during COVID-19.…”

Section: Clinical Data During Acute Covid-19 Infectionmentioning

confidence: 99%

See 1 more Smart Citation

The Relationship between COVID-19 and Hypothalamic–Pituitary–Adrenal Axis: A Large Spectrum from Glucocorticoid Insufficiency to Excess—The CAPISCO International Expert Panel

Jensterle

Herman

Almahmeed³

et al. 2022

IJMS

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Coronavirus disease 2019 (COVID-19) is a highly heterogeneous disease regarding severity, vulnerability to infection due to comorbidities, and treatment approaches. The hypothalamic–pituitary–adrenal (HPA) axis has been identified as one of the most critical endocrine targets of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that might significantly impact outcomes after infection. Herein we review the rationale for glucocorticoid use in the setting of COVID-19 and emphasize the need to have a low index of suspicion for glucocorticoid-induced adrenal insufficiency, adjusting for the glucocorticoid formulation used, dose, treatment duration, and underlying health problems. We also address several additional mechanisms that may cause HPA axis dysfunction, including critical illness-related corticosteroid insufficiency, the direct cytopathic impacts of SARS-CoV-2 infection on the adrenals, pituitary, and hypothalamus, immune-mediated inflammations, small vessel vasculitis, microthrombotic events, the resistance of cortisol receptors, and impaired post-receptor signaling, as well as the dissociation of ACTH and cortisol regulation. We also discuss the increased risk of infection and more severe illness in COVID-19 patients with pre-existing disorders of the HPA axis, from insufficiency to excess. These insights into the complex regulation of the HPA axis reveal how well the body performs in its adaptive survival mechanism during a severe infection, such as SARS-CoV-2, and how many parameters might disbalance the outcomes of this adaptation.

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Changes in Physiological Levels of Cortisol and Adrenocorticotropic Hormone upon Hospitalization Can Predict SARS-CoV-2 Mortality: A Cohort Study

Cited by 27 publications

References 32 publications

Pituitary and SARS CoV-2: An unremitting conundrum

Pituitary and SARS CoV-2: An unremitting conundrum

Adrenal Gland Function and Dysfunction During COVID-19

The Relationship between COVID-19 and Hypothalamic–Pituitary–Adrenal Axis: A Large Spectrum from Glucocorticoid Insufficiency to Excess—The CAPISCO International Expert Panel

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