Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has been associated with various non respiratory manifestations, including those affecting cardiovascular, gastrointestinal, neural, coagulation, and locomotor systems, although endocrine disorders such as diabetes mellitus , thyroiditis ,male infertility , and adrenal insufficiency have been described, but their long-term clinical course remains unclear.

Kai Yoshimura, Kakogawa Medical Center, Japan, and colleagues reported a case study of a 65-year-old man in Japan with long COVID describes how he recovered from certain impaired hormone deficiencies that persisted for more than a year. Days after the patient recovered from respiratory failure and came off a ventilator, he had a sudden drop in blood pressure, which responded to hydrocortisone.

How does the patient present his symptoms? 

The patient in this study was healthy. He was admitted to hospital because he had dyspnea and fever for 8 days and a reverse transcription-polymerase chain reaction (RT-PCR) test that was positive for COVID-19.

He received ciclesonide 200 µg/day for 2 days. Then he was put on a ventilator and the drug was discontinued and favipiravir, ritonavir, and lopinavir were initiated.

The patient had recovered from respiratory failure and was extubated on day 25, and had a negative PCR test on day 31.Five days later, the patient’s blood pressure suddenly dropped from 120/80 mmHg to 80/50 mmHg. His plasma ACTH (adrenocortical hormone) and serum cortisol levels were low, suggesting secondary adrenal insufficiency. The low blood pressure responded to hydrocortisone 100 mg, which was gradually tapered.

On day 96, the patient was discharged from hospital with a dose of 15 mg/day hydrocortisone.

3 months after discharge, an insulin tolerance test revealed that the patient’s ACTH and cortisol had low response, suggestive of adrenal insufficiency. The patient also had moderate growth hormone deficiency and symptoms of hypogonadism so started testosterone therapy.

15 months after discharge, early morning levels of ACTH and cortisol were now in the normal range. The patient discontinued testosterone treatment, but the symptoms returned so he resumed it.

The underlying mechanism by which COVID-19 might trigger pituitary insufficiency is unknown, An exaggerated immune response triggered by SARS-CoV-2 may explain the dysfunction of multiple endocrine organs.

Further study is required to determine whether other COVID-19-associated hormonal disorders share such a transient nature. Given that certain prolonged symptoms of COVID-19 may be caused by hormone deficiency, it might be important to screen for endocrine dysfunction in patients with such persistent symptoms after their recovery from the acute disease.

SOURCE:

Kai Yoshimura , Masaaki Yamamoto , Tomoya Inoue , Hidenori Fukuoka , Keiji Iida , Wataru Ogawa (July 14, 2022). Coexistence of growth hormone, adrenocorticotropic hormone, and testosterone deficiency associated with coronavirus disease 2019: a case followed up for 15 months. Endocrine Journal. Retrieved from : https://pubmed.ncbi.nlm.nih.gov/35831125/ 

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