Attia Amina, Bertherat Jérôme
Université Paris-Cité, Paris, 75006, France.
Department of Endocrinology, Center for Rare Adrenal Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, 75014, France.
Pituitary. 2024 Dec;27(6):945-954. doi: 10.1007/s11102-024-01466-0. Epub 2024 Nov 14.
This review aims to present current data on the course of COVID-19 in patients with Cushing syndrome (CS) and discuss treatment for CS during to the pandemic.
Literature review using PubMed (pubmed.ncbi.nlm.nih.gov). The search included the following terms: "COVID19" in combination with "Cushing syndrome", "Hypercortisolism" and "Glucocorticoid".
Chronic hypercortisolism has been reported to increase infectious risk and worsens prognostic of patients with COVID-19 potentially due to its direct impact on the immune system: lymphopenia, impairment of monocytes and neutrophils activity, diminution of complement activation. Main metabolic complications of CS - i.e. diabetes, hypertension and obesity - have been recognized as COVID-19 complications risk factors. Patients with CS treated with steroidogenesis inhibitors might experience adrenal insufficiency during COVID-19. Special attention should be paid to patients with CS and COVID-19. The pandemic has impacted - and delayed - care of chronic illnesses including CS. Specific recommendations had been provided during the pandemic: favor telemedicine consultations, limit in-hospital explorations and postpone surgery when feasible.
There are enough evidence for an increased prevalence and severity of COVID-19 to recommend a specific attention and caution in patients with CS.
本综述旨在介绍库欣综合征（CS）患者感染新型冠状病毒肺炎（COVID-19）的现有数据，并讨论疫情期间CS的治疗方法。
使用PubMed（pubmed.ncbi.nlm.nih.gov）进行文献综述。检索词包括：“COVID19”与“库欣综合征”、“皮质醇增多症”和“糖皮质激素”的组合。
据报道，慢性皮质醇增多症会增加感染风险，并可能因对免疫系统的直接影响而使COVID-19患者的预后恶化：淋巴细胞减少、单核细胞和中性粒细胞活性受损、补体激活减弱。CS的主要代谢并发症，即糖尿病、高血压和肥胖，已被确认为COVID-19并发症的危险因素。在COVID-19期间，接受类固醇生成抑制剂治疗的CS患者可能会出现肾上腺功能不全。应特别关注CS合并COVID-19的患者。疫情影响并推迟了包括CS在内的慢性病治疗。疫情期间提供了具体建议：优先进行远程医疗咨询，限制住院检查，并在可行的情况下推迟手术。
有足够的证据表明COVID-19的患病率和严重程度增加，建议对CS患者给予特别关注并谨慎对待。
