Successful management of a patient with active Cushing’s disease complicated with coronavirus disease 2019 (COVID-19) pneumonia

Yuno, Akiko; Kenmotsu, Yoshiyuki; Takahashi, Yuka; Nishimura, Hiroshi; Kameda, Hiraku; Cho, Kyu Yong; Nakamura, Akinobu; Yamashita, Yu; Nakamura, Junichi; Nakakubo, Sho; Kamada, Keisuke; Suzuki, Masaru; Sugino, Hirokazu; Inoshita, Naoko; Konno, Satoshi; Miyoshi, Hideaki; Atsumi, Tatsuya; Sawamura, Yutaka; Shimatsu, Akira

doi:10.1507/endocrj.ej20-0613

Cited by 16 publications

(20 citation statements)

References 27 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a young woman with Cushing disease a moderate to severe COVID-19 was reported despite the lack of known risk factors associated with severe SARS-CoV-2 infection [118]. Recently, in a large Italian series of 61 patients with Cushing disease it has been reported that 3.2% of them had confirmed COVID-19 as compared to the 0.6% of the general population.…”

Section: Acth-dependent and Independent Cushing's Syndromementioning

confidence: 99%

COVID-19 and the pituitary

et al. 2021

View full text Add to dashboard Cite

Background Despite COVID-19 being identified as severe respiratory viral infection, progressively many relevant endocrine manifestations have been reported greatly contributing to the severity of the clinical presentation. Systemic involvement in COVID-19 is due to the ubiquitous expression of angiotensin-converting enzyme 2 (ACE2) receptor, responsible for the entry in the cells of SARS-CoV-2, Several reports in humans and animal models showed a significant ACE2 mRNA expression in hypothalamus and pituitary cells. Moreover, higher mortality and poorer outcomes have been widely described in COVID-19 patients with obesity, diabetes and vertebral fractures, which are all highly prevalent in subjects with pituitary dysfunctions. Aim To review the main endocrine manifestations of COVID-19 with their possible implications for pituitary diseases, the possible direct and indirect involvement of the pituitary gland in COVID-19, the impact of COVID-19 on the management of established pituitary diseases which can be already at increased risk for worse outcomes and on neurosurgical activities as well as vaccination. Conclusions Our review underlines that there could be a specific involvement of the pituitary gland which fits into a progressively shaping endocrine phenotype of COVID-19. Moreover, the care for pituitary diseases need to continue despite the restrictions due to the emergency. Several pituitary diseases, such as hypopituitarism and Cushing disease, or due to frequent comorbidities such as diabetes may be a risk factor for severe COVID-19 in affected patients. There is the urgent need to collect in international multicentric efforts data on all these aspects of the pituitary involvement in the pandemic in order to issue evidence driven recommendations for the management of pituitary patients in the persistent COVID-19 emergency.

show abstract

Section: Acth-dependent and Independent Cushing's Syndromementioning

confidence: 99%

COVID-19 and the pituitary

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Presently, there is limited data on treating patients with CS and COVID-19. Yuno et al, described a 27-year-old female with CD who was awaiting pituitary surgery when she developed COVID-19 pneumonia (22). She was treated with a "block-and-replace" regimen using a steroidogenesis inhibitors combination (high dose metyrapone, 4,000 mg/day and trilostane) and hydrocortisone, and a multimodal treatment that included antiviral therapy.…”

Section: Cushing's Disease (Cd)mentioning

confidence: 99%

Pituitary Disorders and COVID-19, Reimagining Care: The Pandemic A Year and Counting

Fleseriu

2021

Front. Endocrinol.

View full text Add to dashboard Cite

“…As the course was particularly severe in a patient with newly diagnosed and florid CS, the authors assumed that the clinical course of COVID-19 might be dependent on severity of hypercortisolism in patients with CS, and that florid CS and COVID-19 are more likely to require emergency care. Two additional manuscripts report single case studies (Table 2): the first one was a 71-year-old man with florid hypercortisolism and past metyrapone therapy, who recovered after one week of isolation [49], the second a 27-year-old woman who was scheduled for pituitary surgery due to Cushing's disease when contracting SARS-CoV-2 [50]. The latter developed COVID-19 pneumonia with a respiratory deterioration and the need for 7 L/min oxygen supply by mask, without further risk factors associated with severe COVID-19.…”

Section: Risk In Endogenous Glucocorticoid Excessmentioning

confidence: 99%

“…After controlling hypercortisolism by a 'block and replace' regime with steroidogenesis inhibitors and hydrocortisone, and a further supportive therapy, the patient improved and was successfully operated one month later. The authors concluded from their case that a multi-disciplinary management with prompt treatment strategies was essential, and that endogenous GC excess could have enhanced the severity of SARS-CoV-2 infection [50].…”

Section: Risk In Endogenous Glucocorticoid Excessmentioning

confidence: 99%

“…Due to the fast onset of action and good effectiveness in controlling hypercortisolism, ketoconazole, metyrapone and osilodrostat should be preferred in florid CS for drug therapy during the pandemic [58,61]. A medical treatment to control hypercortisolism in patients with CS is recommended not only to prevent disease progression but also to correct hypercoagulability and minimize the risk of COVID-19 [50,58]. Since higher levels of cortisol in 24-hour urine collection are associated with an increased risk of infection, the magnitude of elevation should be taken into account in the therapy concept [59].…”

Section: Considerations For Patients With Endogenous Cushing's Syndromementioning

confidence: 99%

See 1 more Smart Citation

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

Vogel

Reincke

2021

Rev Endocr Metab Disord

View full text Add to dashboard Cite

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.

show abstract

Successful management of a patient with active Cushing’s disease complicated with coronavirus disease 2019 (COVID-19) pneumonia

Cited by 16 publications

References 27 publications

COVID-19 and the pituitary

COVID-19 and the pituitary

Pituitary Disorders and COVID-19, Reimagining Care: The Pandemic A Year and Counting

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

Contact Info

Product

Resources

About