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Updated: Dec 3, 2025
Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
Catecholamine physiology and its implications in patients with COVID-19
Sriram Gubbi1, Matthew A Nazari2, David Taieb3
1Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA.
Insights
Severe COVID-19 shares traits with catecholamine excess, like hypertension. Studying catecholamine-secreting tumors (phaeochromocytoma and paraganglioma) offers insights into managing critical illness in COVID-19 patients.
Area of Science:
- Endocrinology
- Infectious Diseases
- Cardiovascular Medicine
Background:
- Severe COVID-19 risk factors mirror catecholamine excess symptoms such as hypertension and immune dysregulation.
- Directly studying catecholamines in critically ill COVID-19 patients is challenging due to illness severity and confounding treatments.
- Phaeochromocytoma and paraganglioma (PPGL) are well-characterized catecholamine-secreting tumors, providing a model for studying catecholamine effects.
Purpose of the Study:
- To explore the potential role of catecholamines in severe COVID-19 pathogenesis.
- To discuss the management of catecholamine excess states and its relevance to COVID-19 critical care.
- To leverage insights from phaeochromocytoma and paraganglioma research for understanding COVID-19.
Main Methods:
- Review and synthesis of existing literature on COVID-19, catecholamine physiology, and PPGL.
- Comparative analysis of clinical manifestations between severe COVID-19 and catecholamine excess states.
- Discussion of therapeutic strategies for catecholamine excess applicable to COVID-19.
Main Results:
- Clinical similarities suggest a potential shared pathophysiological basis involving catecholamines in severe COVID-19.
- PPGL research offers a valuable framework for understanding catecholamine-driven complications in critical illness.
- Management strategies for catecholamine excess may inform COVID-19 treatment, particularly in critical care settings.
Conclusions:
- Catecholamines likely play a significant role in the pathophysiology of severe COVID-19.
- Understanding catecholamine excess, informed by PPGL studies, is crucial for managing critical COVID-19 patients.
- Further research into catecholamine modulation could yield novel therapeutic approaches for severe COVID-19.
Abstract:
The risk factors for severe COVID-19 are diverse, yet closely resemble the clinical manifestations of catecholamine excess states (eg, hypertension, cardiovascular disease, immune dysregulation, and hyperglycaemia), suggesting a potentially common basis for disease. Unfortunately, severe illness (eg, respiratory failure, compromised cardiac function, and shock) incurred by COVID-19 hinders the direct study of catecholamines in these patients, especially among those on multiple medications or those on adrenaline or noradrenaline infusions, or both. Phaeochromocytoma and paraganglioma (PPGL) are tumours that secrete catecholamines, namely adrenaline and noradrenaline, often in excess. PPGL are well studied disease processes in which the effects of catecholamines are easily discernible and therefore their potential biochemical and physiological influences in patients with COVID-19 can be explored. Because catecholamines are expected to have a role in patients with critical illness, patients on vasopressor infusions, and patients who sustain some acute and chronic physical stresses, the challenges involved in the management of catecholamine excess states are directly relevant to the treatment of patients with COVID-19. In this Personal View, we discuss the complex interplay between catecholamines and COVID-19, and the management of catecholamine excess states, while referencing relevant insights derived from the study of PPGL.
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