Long COVID and pituitary dysfunctions: a bidirectional relationship?

Area of Science:

• Endocrinology
• Infectious Diseases
• Pathophysiology

Background:

• Long COVID, a syndrome following SARS-CoV-2 infection, significantly impacts patient quality of life.
• The underlying pathophysiology of Long COVID remains poorly understood, with hormonal dysregulation proposed as a key factor.
• Alterations in the hypothalamic-pituitary axes are increasingly implicated in the development and persistence of Long COVID symptoms.

Purpose of the Study:

• To review and discuss the role of hormonal dysfunctions in the hypothalamic-pituitary axes in Long COVID.
• To highlight the potential negative implications of these endocrine alterations on the Long COVID syndrome.
• To synthesize current evidence on pituitary function in COVID-19 survivors.

Main Methods:

• Literature review of studies investigating hormonal axes in Long COVID and COVID-19 survivors.
• Analysis of data concerning the hypothalamic-pituitary-adrenal (HPA) axis, hypothalamic-pituitary-gonadal (HPG) axis, hypothalamic-pituitary-thyroid (HPT) axis, and hypothalamic-growth hormone (GH) axis.
• Synthesis of findings related to central adrenal insufficiency, hypogonadism, hypothyroidism, and GH deficiency.

Main Results:

• The HPA axis is frequently impaired in Long COVID, leading to subclinical central adrenal insufficiency.
• High prevalence of central hypogonadism observed in COVID-19 survivors months post-recovery.
• Hypothalamic-GH axis impairment is reported, while the HPT axis appears largely preserved in survivors.

Conclusions:

• Hormonal dysfunctions, particularly involving the pituitary gland, may represent a significant pathophysiological mechanism in Long COVID.
• These findings suggest a potential pituitary-centered view of Long COVID.
• Further large-scale clinical studies are needed to confirm these implications for diagnosis and treatment.