Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia.
Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia.
Endocr Pract. 2021 Feb;27(2):83-89. doi: 10.1016/j.eprac.2020.10.014. Epub 2020 Dec 15.
To study the adrenocortical response to an acute coronavirus disease-2019 (COVID-19) infection.
Morning plasma cortisol, adrenocorticotropic hormone (ACTH), and dehydroepiandrosterone sulfate levels were measured in 28 consecutive patients with COVID-19 (16 men, 12 women, median age 45.5 years, range 25-69 years) on day 1 to 2 of hospital admission. These tests were repeated twice in 20 patients and thrice in 15 patients on different days. The hormone levels were correlated with severity of the disease.
The median morning cortisol level was 196 (31-587) nmol/L. It was <100 nmol/L in 8 patients (28.6%), <200 nmol/L in 14 patients (50%), and <300 nmol/L in 18 patients (64.3%). The corresponding ACTH values had a median of 18.5 ng/L (range 4-38 ng/L), and the ACTH level was <10 ng/L in 7 patients (26.9%), <20 ng/L in 17 patients (60.7%), and <30 ng/L in 23 patients (82.1%). The repeated testing on different days showed a similar pattern. Overall, if a cutoff level of <300 nmol/L is considered abnormal in the setting of acute disease, 9 patients (32%) had cortisol levels below this limit, regardless of whether the test was done only once (3 patients) or 3 times (6 patients). When the disease was more severe, the patients had lower cortisol and ACTH levels, suggesting a direct link between the COVID-19 infection and impaired glucocorticoid response.
Unexpectedly, the adrenocortical response in patients with COVID-19 infection was impaired, and a significant percentage of the patients had plasma cortisol and ACTH levels consistent with central adrenal insufficiency.
研究急性 2019 冠状病毒病（COVID-19）感染对肾上腺皮质的反应。
连续测量 28 例 COVID-19 住院患者（16 名男性，12 名女性，中位年龄 45.5 岁，范围 25-69 岁）入院第 1-2 天的清晨血浆皮质醇、促肾上腺皮质激素（ACTH）和硫酸脱氢表雄酮水平。20 例患者在不同日期重复进行了 2 次检测，15 例患者重复进行了 3 次检测。激素水平与疾病严重程度相关。
清晨皮质醇中位水平为 196（31-587）nmol/L。8 例患者（28.6%）<100 nmol/L，14 例患者（50%）<200 nmol/L，18 例患者（64.3%）<300 nmol/L。相应的 ACTH 值中位数为 18.5ng/L（范围 4-38ng/L），7 例患者（26.9%）<10ng/L，17 例患者（60.7%）<20ng/L，23 例患者（82.1%）<30ng/L。不同日期的重复检测显示出相似的模式。总体而言，如果将<300nmol/L 的临界值视为急性疾病中的异常值，9 例患者（32%）的皮质醇水平低于该限值，无论仅进行 1 次（3 例）还是 3 次（6 例）检测。当疾病更严重时，患者的皮质醇和 ACTH 水平较低，提示 COVID-19 感染与糖皮质激素反应受损之间存在直接联系。
出乎意料的是，COVID-19 感染患者的肾上腺皮质反应受损，相当比例的患者存在与中枢肾上腺功能不全一致的血浆皮质醇和 ACTH 水平。
