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Low morning cortisol is rare in long COVID (LC) patients, with most exhibiting normal or elevated levels. This study emphasizes considering circadian timing for accurate cortisol interpretation in LC.

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Area of Science:

  • Endocrinology
  • Infectious Diseases
  • Neuroscience

Background:

  • Cortisol dysregulation is a proposed biomarker for long COVID (LC), but existing research shows inconsistent findings.
  • Previous studies suggested low cortisol in LC, yet varied collection times and study designs limit conclusions.
  • Understanding cortisol patterns is crucial for identifying potential biomarkers and understanding LC pathophysiology.

Purpose of the Study:

  • To evaluate morning serum cortisol distributions in an independent long COVID cohort.
  • To account for circadian timing and sleep patterns in cortisol level assessments.
  • To investigate the utility of cortisol as a biomarker for long COVID.

Main Methods:

  • Retrospective cross-sectional study of 86 adults at the Stanford Long COVID Clinic.
  • Morning serum cortisol measured between 05:00-10:00, categorized into early morning peak (EMP) and mid-morning peak (MMP) windows.
  • Analysis included Alliance Sleep Questionnaire (ASQ) data and inflammatory markers (CRP, D-dimer).

Main Results:

  • The mean serum cortisol level was 15.67 ± 6.76 μg/dL.
  • Only 1.2% of patients had low cortisol; 62.8% were normal, and 36.0% were elevated.
  • Cortisol distributions showed no significant differences between EMP and MMP collection times or by sleep alignment.

Conclusions:

  • Contrary to prior reports, low morning cortisol is uncommon in this long COVID cohort.
  • Most patients presented with normal or elevated cortisol levels, irrespective of collection time.
  • Circadian timing is critical for interpreting cortisol in long COVID; further prospective studies are needed.