Adrenal Gland Function and Dysfunction During COVID-19

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is currently one of the major health concerns worldwide accounting for many deaths and posing a great social and economic burden. Early activation of adrenal hormone secretion is pivotal to surviving systemic microbial infections. In addition, clinical studies demonstrated that glucocorticoids might also be beneficial in reducing disease progression and life deterioration in certain patients with COVID-19. Recent studies demonstrated that SARS-CoV-2 might target the adrenal glands, raising the possibility that at least some COVID-19 complications may be associated with adrenal dysfunction. Whether SARS-CoV-2 infection might cause adrenal dysfunction remains unknown. Histopathological examinations provided evidence that SARS-CoV-2 infection might indeed cause certain structural damage to the adrenal glands, especially concerning its vascular system. However, since no widespread cellular damage to cortical cells was observed, it is less likely that those changes could lead to an immediate adrenal crisis. This assumption is supported by the limited number of studies reporting rather adequate cortisol levels in patients with acute COVID-19. Those studies, however, could not exclude a potential late-onset or milder form of adrenal insufficiency. Although structural damage to adrenal glands is a rarely reported complication of COVID-19, some patients might develop a critical illness-related corticosteroid insufficiency (CIRCI), or iatrogenic adrenal insufficiency resulting from prolonged treatment with synthetic glucocorticoids. In this mini-review article, we aimed at describing and discussing factors involved in the adrenal gland function and possible dysfunction during COVID-19.

The Impact of Information About COVID-19 on the Endocrine Stress System and Cognitive Distortions

“…An adequate and balanced response to stress is detrimental to human health as excessive or chronic activation of the hypothalamus-pituitary-adrenal axis and the sympathoadrenal system, also known as the endocrine stress system, is associated with the pathogenesis of various human diseases and psychological disorders, including metabolic syndrome, anxiety, or post-traumatic stress disorder (PTSD) 2 3 4 5 . Recent studies have demonstrated that patients with severe COVID-19 have a pronounced elevation in the plasma stress hormones 6 . Interestingly, an elevation of adrenal glucocorticoids in the plasma might persist long after the initial infection with coronavirus, as shown in the case of survivors of the SARS-CoV-1 pandemic 7 .…”

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Recent studies have demonstrated that patients with severe COVID-19 have a pronounced elevation in the plasma stress hormones [6]. Interestingly, an elevation of adrenal glucocorticoids in the plasma might persist long after the initial infection with coro-Review

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Fatigue in Post-Acute Sequelae of Coronavirus Disease 2019

“…Some authors 25 have suggested that primary adrenal gland insufficiency specifically may be underdiagnosed among PASC. COVID-19 infection may impact the adrenal glands by both direct and indirect mechanisms.…”

“…From a cellular level, SARS-CoV-2 binds preferentially to angiotensin converting enzyme 2 (ACE 2). Various studies have suggested that ACE 2 is expressed on adrenal glands and that SARS-CoV-2 may have a propensity to replicate within these cells 25 . However, there has been no direct evidence of cellular damage in these tissues.…”

The Role of Endocrine and Metabolic System in COVID-19 Disease – The Transcampus Experience and Review of Evidence From International Collaborating Groups

“…In the second part of this issue, aspects linking endocrine diseases with COVID-19 are presented. Specifically, Kanczkowski et al [6] describe how COVID-19 infection may cause adrenal gland damage both directly and indirectly and how it may impair adrenal gland function both in the short-as well as in the long-term. Tsourdi et al [7] summarize the evidence from preclinical models and clinical studies about the effects of COVID-19 and its treatments on bone metabolism and they discuss how osteoporosis medications may have beneficial effects on the clinical course of COVID-19.…”