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Horm Metab Res 2022; 54(03): 153-161
DOI: 10.1055/a-1764-1260
Endocrine Care

Assessment of Neuroendocrine Changes and Hypothalamo-Pituitary Autoimmunity in Patients with COVID-19

Mustafa Sait Gonen 
1   Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Annamaria De Bellis 
2   Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples, Italy
,
Emre Durcan 
1   Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Giuseppe Bellastella 
2   Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, Naples, Italy
,
Paolo Cirillo
3   Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
,
Lorenzo Scappaticcio
3   Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
,
Miriam Longo
3   Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
,
Basak Ecem Bircan 
1   Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Serdar Sahin 
1   Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Cem Sulu 
1   Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Hande Mefkure Ozkaya 
1   Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Dildar Konukoglu 
4   Department of Medical Biochemistry, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Fatma Ferda Kartufan 
5   Department of Anaesthesiology and Reanimation, Yeditepe University, Istanbul, Turkey
,
Fahrettin Kelestimur 
6   Department of Endocrinology, Yeditepe University, Istanbul, Turkey
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Abstract

SARS-CoV-2 may affect the hypothalamic-pituitary axis and pituitary dysfunction may occur. Therefore, we investigated neuroendocrine changes, in particular, secondary adrenal insufficiency, using a dynamic test and the role of autoimmunity in pituitary dysfunction in patients with COVID-19. The single-center, prospective, case-control study included patients with polymerase chain reaction (PCR)-confirmed COVID-19 and healthy controls. Basal hormone levels were measured, and the adrenocorticotropic hormone (ACTH) stimulation test was performed. Antipituitary (APA) and antihypothalamic antibodies (AHA) were also determined. We examined a total of 49 patients with COVID-19 and 28 healthy controls. The frequency of adrenal insufficiency in patients with COVID-19 was found as 8.2%. Patients with COVID-19 had lower free T3, IGF-1, and total testosterone levels, and higher cortisol and prolactin levels when compared with controls. We also demonstrated the presence of APA in three and AHA in one of four patients with adrenal insufficiency. In conclusion, COVID-19 may result in adrenal insufficiency, thus routine screening of adrenal functions in these patients is needed. Endocrine disturbances in COVID-19 are similar to those seen in acute stressful conditions or infections. Pituitary or hypothalamic autoimmunity may play a role in neuroendocrine abnormalities in COVID-19.

Key words

COVID-19 - hypothalamic-pituitary axis - antihypothalamic antibodies - antipituitary antibodies - ACTH stimulation test - adrenal insufficiency


Publication History

Received: 21 November 2021

Accepted after revision: 27 January 2022

Article published online:
11 March 2022

© 2022. Thieme. All rights reserved.

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