Delayed Onset of Central Hypocortisolism in a Patient Recovering From COVID-19

Chua, Marvin Wei Jie; Chua, Melvin Peng Wei

doi:10.1016/j.aace.2020.11.001

Cited by 19 publications

(18 citation statements)

References 15 publications

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“…44 Moreover, a case of delayedonset central AI has been described during the convalescent phase of COVID-19. 45 Thus, not only the aforementioned data appear conflicting, but also the disparate sample sizes make these studies impossible to compare outside of a systematic review.…”

Section: Covid-19 and Adrenal Functionmentioning

confidence: 99%

“…Still another study with nine critically ill patients with COVID-19, six (66.7%) had random plasma cortisol concentrations below 10 μg/dl, which met the criteria for the diagnosis of CIRCI ( 44 ). Besides, a case of delayed-onset central AI has been described during the convalescent phase of COVID-19 ( 45 ). Thus, the aforementioned data not only appear conflicting, the disparate sample sizes make these studies impossible to compare outside of a systematic review.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Endocrine Follow-up During Post-Acute COVID-19: Practical Recommendations Based on Available Clinical Evidence

et al. 2022

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Section: Covid-19 and Adrenal Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endocrine Follow-up During Post-Acute COVID-19: Practical Recommendations Based on Available Clinical Evidence

et al. 2022

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“…Even if our hypothesis seems strengthened by the above evidence, we must consider as major limitation the impossibility to directly demonstrate the presence of virus in the hypothalamic tissue in vivo. Otherwise, it is also true that this limitation is frequently present in many reports regarding the interaction between SARS-CoV-2 infection and glands (11,26,42).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Hypothalamic Amenorrhea Following COVID-19 Infection and Review of Literatures

et al. 2022

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SARS-CoV-2 infection, responsible for the coronavirus disease 2019 (COVID-19), can impair any organ system including endocrine glands. However, hypothalamic–pituitary dysfunctions following SARS-CoV-2 infection remain largely unexplored. We described a case of hypothalamic amenorrhea following SARS-CoV-2 infection in a 36-year-old healthy woman. The diagnostic workup excluded all the causes of secondary amenorrhea, in agreement to the current guidelines, whereas the gonadotropin increase in response to GnRH analogue tests was suggestive for hypothalamic impairment. Therefore, since our patient did not present any organic cause of hypothalamic–pituitary disorder, we hypothesized that her hypothalamic deficiency may have been a consequence of SARS-CoV-2 infection. This assumption, besides on the temporal consecutio, is strengthened by the fact that SARS-CoV-2 infection can impair the hypothalamic circuits, altering the endocrine axes, given that angiotensin-converting enzyme 2 receptors have also been observed in the hypothalamus. We reviewed the literature regarding hypothalamic–pituitary dysfunction in patients with SARS-CoV-2 infection. No study has previously described female hypogonadotropic hypogonadism with secondary amenorrhea following COVID-19. We suggest clinicians focusing greater attention on this possible endocrine disorder.

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“…Table 4 summarizes the case reports of pituitary insufficiency in association with COVID-19. [48][49][50][51][52] Hypopituitarism per se is associated with increased morbidity and mortality, mainly due to cardiovascular disease, a significant risk factor for COVID-19 disease severity. [48] Alzahrani et al [53] concluded that the adrenocortical response in patients with COVID-19 infection was impaired.…”

Section: Pituitary Insufficiencymentioning

confidence: 99%

The pituitary gland in the COVID-19 pandemic: A narrative review of the literature

Almalki

Aldahmani

Mahzari

et al. 2021

Journal of Diabetes and Endocrine Practice

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Review Article introduCtion COVID-19 is a novel coronavirus responsible for a pandemic that emerged in December 2019. Heterogeneous clinical forms are described from asymptomatic to severe hypoxaemic acute respiratory syndrome with multisystem organ failure. [1] COVID-19 infection has tremendously impacted social living and clinical practice, education, and research. [2,3] Almost all organs and systems suffer from COVID19 infection. Endocrine conditions are not an exception, and some endocrine organs are at risk of a direct or indirect damage by COVID-19. [4] Endocrine treatment modifications due to COVID-19 infection are required proactively to avoid decompensation and eventual hospital admission. This case was most evident in diabetes and adrenal insufficiency, in which rapid increase of "replacement" therapy is warranted by adopting the appropriate sick day's rules and easy contact with the health care provider through different telematic modalities. [5] The COVID-19 pandemic has had implications in the central nervous system. COVID-19 infection is characterized by coagulation activation and endothelial dysfunction, causing the endocrine system's ischemic and hemorrhagic vascular syndromes. We aimed to provide an overview of the global literature on the impact of COVID-19 on pituitary function and structure. A narrative, nonsystematic review of the literature retrieved from a significant medical online database (PubMed) between February 1, 2020 and June 30, 2021. The relevant literature was narrated in a concise thematic account. Most specific recommendations for managing endocrine disorders during COVID-19 rely on the same principles of epidemiological safety measures, delaying nonemergency admissions and transforming the routine follow-up to telemedicine clinics. Ongoing medications should be continued. Special attention is required to both primary and secondary adrenal disorders. Corticosteroids are a mainstay of treatment in COVID-19 infection. Therefore, it is essential to consider all aspects of high doses, including adverse metabolic reactions, especially in people with diabetes and prediabetes. Surgery is postponed for nonemergency situations, restricting most planned surgeries, and if required in an emergency, plans should include an additional risk. Sick-day rules should be adhered to strictly. Regular contact with endocrinology teams can be maintained through teleconsultations and virtual clinics. In conclusion, special attention is needed to the interaction between COVID-19 infection and pituitary conditions in a bidirectional manner. The direct impact of COVID-19 on pituitary structure and function is possible and should be recognized timely and treated effectively. Furthermore, appropriate organizational adjustments are needed to maintain a coordinated response within the conventional multidisciplinary management to optimize the care of patients with pituitary conditions among the ongoing COVID-19 pandemic.

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Delayed Onset of Central Hypocortisolism in a Patient Recovering From COVID-19

Cited by 19 publications

References 15 publications

Endocrine Follow-up During Post-Acute COVID-19: Practical Recommendations Based on Available Clinical Evidence

Endocrine Follow-up During Post-Acute COVID-19: Practical Recommendations Based on Available Clinical Evidence

Case Report: Hypothalamic Amenorrhea Following COVID-19 Infection and Review of Literatures

The pituitary gland in the COVID-19 pandemic: A narrative review of the literature

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