THE IMPACT OF COVID-19 VIRAL INFECTION ON THE HYPOTHALAMIC PITUITARY ADRENAL AXIS

Alzahrani, Ali S.; Mukhtar, Noha; Aljomaiah, Abeer; Aljamei, Hadeel; Bakhsh, Abdulmohsen; Alsudani, Nada; Elsayed, Tarek; Alrashidi, Nahlah; Fadel, Roqayh; Alqahtani, Eman; Raef, Hussein; Butt, Muhammad Imran; Sulaiman, Othman

CONTEXT: There are minimal data on the effects of COVID-19 on the endocrine organs. OBJECTIVE: To study the adrenocortical response to the acute COVID-19 infection METHODS: Morning plasma cortisol, ACTH and DHEAS were measured on day 1-2 of admission of 28 consecutive COVID-19 patients (16 males, 12 females, median age 45.5 years, range, 25-69). These tests were repeated twice in 20 patients and thrice in 15 patients on different days. The hormone levels were correlated with the severity of illness RESULTS: The median morning cortisol was 196 nmol/l (31-587). It was < 100 nmol/l in 8 patients (28.6%), < 200 nmol/l in 14 patients (50%) and < 300 nmol/l in 18 patients (64.3%). The corresponding ACTH values include a median of 18.5 ng/l (range 4-38), ACTH <10 ng/l in 7 patients (26.9%), < 20 ng/l in 17 patients (60.7%) and < 30 ng/l in 23 patients (82.1%). Repeated testing on different days showed a similar pattern. Overall, if a cutoff level of < 300 nmol/l is considered abnormal in the setting of acute illness, 9 patients (32%) had cortisol levels below this limit whether the test was done once only (3 patients) or three times (6 patients). The more severe the illness, the more patients with low cortisol and ACTH levels, suggesting a direct link between the COVID-19 infection and the impaired glucocorticoid response. CONCLUSIONS: Unexpectedly, the adrenocortical response in COVID-19 infection is impaired and a significant percentage of patients had plasma cortisol and ACTH consistent with central adrenal insufficiency.