Hypothalamic-Pituitary Adrenal Axis Status 3 Months After Recovery From COVID-19 Infection

Area of Science:

• Endocrinology
• Infectious Diseases
• Pulmonology

Background:

• Coronavirus disease 2019 (COVID-19) primarily affects the lungs but can impact other systems, including the hypothalamic-pituitary-adrenal (HPA) axis, due to ACE2 receptor expression.
• Limited data exists on the long-term effects of COVID-19 on the HPA axis following acute infection.

Purpose of the Study:

• To evaluate and compare changes in the HPA axis in mild, moderate, and severe COVID-19 cases at least 3 months post-infection.
• To assess the prevalence of adrenal insufficiency (AI) in COVID-19 survivors.

Main Methods:

• A prospective, observational study involving 66 COVID-19 subjects (≥18 years) assessed ≥3 months after recovery.
• Serum cortisol levels were measured at baseline and 30, 60 minutes after a 1-μg short Synacthen test (SST) in fasting individuals.

Main Results:

• 13.63% (9/66) of subjects exhibited peak serum cortisol <496.62 nmol/L, indicating potential adrenal insufficiency.
• No significant difference in SST peak cortisol levels was observed across mild, moderate, and severe COVID-19 groups.
• Six subjects with AI at follow-up showed normalized HPA axis function after 12 months.

Conclusions:

• The hypothalamic-pituitary-adrenal axis can be affected in a significant portion of COVID-19 survivors.
• Adrenal insufficiency following COVID-19 may be transient and resolve spontaneously.
• Findings underscore the importance of clinical monitoring and long-term follow-up for COVID-19 patients.