Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

Abstract

Patients with endogenous or exogenous glucocorticoid (GC) excess exhibit a range of side effects, including an increased risk of infections. Via both mechanism, immune impairments and cardiometabolic concomitant diseases, patients with GC excess could be at increased risk for COVID-19. The impact on incidence and outcome of a SARS-CoV-2 infection in this population are not yet completely clear. This review aims to compile the data available to date and to discuss the existing literature on this topic. Further we highlight potential effects of SARS-CoV-2 on the hypothalamic-pituitary-adrenal axis as well as the influence of endogenous or exogenous GC excess on SARS-CoV-2 mRNA vaccination. There is growing evidence suggesting an increased risk of infection and severe outcome in patients with high-dose GC therapy after contracting SARS-CoV-2. The few data and case reports on patients with endogenous GC excess and SARS-CoV-2 infection point in a similar direction: chronic GC excess seems to be associated with an unfavorable course of COVID-19. Whether this is mainly a primary immune-mediated effect, or also triggered by the many GC-associated comorbidities in this population, is not yet fully understood. Patients with endogenous or exogenous GC excess should be considered as a vulnerable group during the SARS-CoV-2 pandemic. Regardless of the cause, vaccination and consistent surveillance and control of associated comorbidities are recommended.

Praktische Empfehlungen zum Screening und Management von Funktionsstörungen der Nebennierenrinde bei einer akuten SARS-CoV-2-Infektion

“…Es ist unklar, ob Patient*innen mit endogenem Hyperkortisolismus oder unter einer Glukokortikoidtherapie eine unzureichende Immunantwort auf SARS-CoV-2-mRNA-Impfstoffe haben. Allerdings ist zu vermuten, dass bei einem Hyperkortisolismus die Wirksamkeit der Impfstoffe durch die immunsuppressive Wirkung vermindert ist [ 17 – 19 ]. Unter diesen Gesichtspunkten erscheint es plausibel anzunehmen, dass der klinische Verlauf einer SARS-CoV-2-Infektion vom Schweregrad eines Hyperkortisolismus abhängig ist.…”

Successful Immunomodulatory Treatment of COVID-19 in a Patient With Severe ACTH-Dependent Cushing’s Syndrome: A Case Report and Review of Literature

“…This is accordant with studies on patients on exogenous glucocorticoid (GC) treatment. Overall, there is a growing body of evidence that patients on chronic GC therapy are at higher risk for SARS-CoV-2 infection and a severe course of disese, regardless of age and comorbidities ( 14 ). In many studies patients on high-dose GC therapy were at particularly high risk for a severe course of disease, so it is reasonable to assume that there is a dose-dependent effect ( 14 ).…”

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

“…Many potential beneficial effects of glucocorticoids in the treatment of COVID-19 have been proposed. However, whether they are successful due to the general supportive benefits of glucocorticoids in critically ill patients, mitigation of the cytokine release syndrome and ARDS [12,16], the treatment of undiagnosed adrenal insufficiency (AI) [17,18], or the suppression of endogenous cortisol secretion with reduced effects on mineralocorticoid receptors [19] has yet to be clarified [20].…”