Is there a role for the adrenal glands in long COVID?

Kanczkowski, Waldemar; Beuschlein, Felix; Bornstein, Stefan R.

doi:10.1038/s41574-022-00700-8

Cited by 24 publications

(27 citation statements)

References 10 publications

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“…However, Salzano et al described adrenal insufficiency in a patient with COVID-19 who was treated with dexamethasone and was suffered from long COVID symptoms persisting for 3 months [ 55 ]. Therefore, adrenal insufficiency may need to be considered in patients with long COVID symptoms [ 56 ].…”

Section: Long Covid and Hypertension-related Organsmentioning

confidence: 99%

Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19

et al. 2022

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s The coronavirus disease 2019 (COVID-19) affects infected patients even after the acute phase and impairs their health and quality of life by causing a wide variety of symptoms, referred to as long COVID. Although the evidence is still insufficient, hypertension is suspected to be a potential risk factor for long COVID, and the occurrence of cardiovascular diseases seems to be a key facet of multiple conditions observed in long COVID. Nonetheless, there are few reports that comprehensively review the impacts of long COVID on hypertension and related disorders. As a sequel to our previous report in 2020 which reviewed the association of COVID-19 and hypertension, we summarize the possible influences of long COVID on hypertension-related organs, including the cardiovascular system, kidney, and endocrine system, as well as the pathophysiological mechanisms associated with the disorders in this review. Given that the clinical course of COVID-19 is highly affected by age and sex, we also review the impacts of these factors on long COVID. Lastly, we discuss areas of uncertainty and future directions, which may lead to better understanding and improved prognosis of clinical problems associated with COVID-19.

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Section: Long Covid and Hypertension-related Organsmentioning

confidence: 99%

Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19

et al. 2022

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“…Long COVID syndrome is an attention-gaining result of COVID-19 characterized by signs and symptoms of the disease persisting beyond the acute infection [ 30 ]. Interestingly, some of the proposed explanations of this phenomenon include reduced adrenal reserve and/or development of adrenal insufficiency [ 31 , 32 , 33 ]. This can be, at least to some extent, explained either by the destruction of the adrenal glands (primary adrenal insufficiency), or the inhibitory effect of glucocorticoids used as anti-COVID-19 medications on the pituitary (secondary adrenal insufficiency) [ 15 , 31 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, some of the proposed explanations of this phenomenon include reduced adrenal reserve and/or development of adrenal insufficiency [ 31 , 32 , 33 ]. This can be, at least to some extent, explained either by the destruction of the adrenal glands (primary adrenal insufficiency), or the inhibitory effect of glucocorticoids used as anti-COVID-19 medications on the pituitary (secondary adrenal insufficiency) [ 15 , 31 , 33 , 34 ]. Whenever there is a clinical suspicion of adrenal insufficiency, the patient should undergo a swift work-up to confirm or exclude the diagnosis [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Cortisol as an Independent Predictor of Unfavorable Outcomes in Hospitalized COVID-19 Patients

Świątkowska−Stodulska

Berlińska

Puchalska-Reglińska³

2022

Biomedicines

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Most cases of COVID-19 are non-severe, but some patients require urgent hospital care. In the past, it has been established that adrenal hyperactivity predicts poorer prognosis in severely ill patients. We wanted to verify if cortisol levels can be tied to clinical outcomes and the degree of inflammation in hospitalized COVID-19 patients. We recruited 180 adult patients with PCR-confirmed COVID-19. The group was divided into smaller subgroups based on the glucocorticoid treatment status; the subgroups were evaluated in three separate time points. The assessment involved hormonal function (cortisol, ACTH), inflammatory markers, and occurrence of the pre-selected endpoints (death, hospitalization ≥10 days, non-invasive ventilation or high-flow oxygenation, mechanical ventilation, vasopressors). In the evaluated group, 121 patients showed signs of abnormal adrenal function. There was a clear correlation between cortisol and IL-6 concentrations in all three time points regardless of glucocorticoid treatment. A total of 71.1% of patients displaying abnormal cortisol production met the preselected endpoints. Our analysis showed that a cutoff cortisol concentration prognosing endpoint occurrence could be set at 15.45 μg/dL for patients not treated with glucocorticoids. Cortisol concentration can be seen as an independent prognostic factor for unfavorable outcomes in selected adults hospitalized with COVID-19.

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“…Also, the Epstein virus and herpesviruses reactivation has been associated with low cortisol levels [ 62 ]. The causes underlying hypocortisolemia could be multiple and are under investigation: direct infection of the adrenal gland, glucocorticoid receptor alpha tissue resistance, the onset of secondary adrenal gland insufficiency due to glucocorticoid therapy, and the appearance of anti-adrenocorticotropic hormone (ACTH) antibodies have been reported [ 63 ]. Low levels of cortisol associated with altered HPA axis have also been described in other clinical conditions such as chronic fatigue syndrome and myalgic encephalomyelitis/fibromyalgia.…”

Section: The Molecular Hallmarks and Dysfunctions Of Long Covid-19mentioning

confidence: 99%

The Challenge of Long COVID-19 Management: From Disease Molecular Hallmarks to the Proposal of Exercise as Therapy

Scurati

Papini

Giussani

et al. 2022

IJMS

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Long coronavirus disease 19 (COVID-19) is the designation given to a novel syndrome that develops within a few months after infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and that is presenting with increasing incidence because of the numerous cases of infection. Long COVID-19 is characterized by a sequela of clinical symptoms that concern different organs and tissues, from nervous, respiratory, gastrointestinal, and renal systems to skeletal muscle and cardiovascular apparatus. The main common molecular cause for all long COVID-19 facets appears to be related to immune dysregulations, the persistence of inflammatory status, epigenetic modifications, and alterations of neurotrophin release. The prevention and management of long COVID-19 are still inappropriate because many aspects need further clarification. Exercise is known to exert a deep action on molecular dysfunctions elicited by long COVID-19 depending on training intensity, duration, and continuity. Evidence suggests that it could improve the quality of life of long COVID-19 patients. This review explores the main clinical features and the known molecular mechanisms underlying long COVID-19 in the perspective of considering exercise as a co-medication in long COVID-19 management.

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Is there a role for the adrenal glands in long COVID?

Abstract: The symptoms of long COVID and chronic adrenal insufficiency have striking similarities. Therefore, we aim to raise awareness of assessing adrenal function in patients with long COVID.

Cited by 24 publications

References 10 publications

Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19

Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19

Cortisol as an Independent Predictor of Unfavorable Outcomes in Hospitalized COVID-19 Patients

The Challenge of Long COVID-19 Management: From Disease Molecular Hallmarks to the Proposal of Exercise as Therapy

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