Hypothalamic-Pituitary Axis Function and Adrenal Insufficiency in COVID-19 Patients.

IF 2.2 4区 医学 Q3 ENDOCRINOLOGY & METABOLISM
Neuroimmunomodulation Pub Date : 2023-01-01 Epub Date: 2023-09-13 DOI:10.1159/000534025
Emre Durcan, Aysa Hacioglu, Zuleyha Karaca, Kursad Unluhizarci, Mustafa Sait Gonen, Fahrettin Kelestimur
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引用次数: 0

Abstract

The outbreak of COVID-19 has affected more than half a billion people worldwide and caused more than 6 million deaths since 2019. The responsible virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily affects the lungs, but it has multisystemic effects. It is well known that dysfunction of multiple endocrine organs may occur during or after COVID-19. Impairment of the hypothalamic-pituitary-adrenal (HPA) axis is of utmost importance as it may lead to death if went undiagnosed. SARS-CoV-2 may cause both primary and secondary adrenal insufficiencies (AIs). The clinical manifestations of AI are generally non-specific and might be attributed to the complications caused by the infection itself. The underlying pathogenetic mechanisms were explained by the immunogenic, vascular effects of the infection or the direct effects of the virus. The diagnosis of AI in critically ill patients with COVID-19 is not straightforward. There is lack of consensus on the cut-off values of basal serum cortisol levels and stimulation tests during the disease. Here we review the literature with a special regard on the evaluation of the HPA axis in patients with COVID-19. We conclude that the possibility of AI should always be kept in mind when dealing with patients with COVID-19, and repeated basal cortisol measurements and the ACTH stimulation test results could guide the clinician during the diagnostic process.

新冠肺炎患者的下丘脑-垂体轴功能和肾上腺功能不全。
自2019年以来,新冠肺炎疫情已影响全球5亿多人,造成600多万人死亡。负责任的病毒,严重急性呼吸综合征冠状病毒2型,主要影响肺部,但具有多系统影响。众所周知,新冠肺炎期间或之后可能会出现多种内分泌器官功能障碍。下丘脑-垂体-肾上腺(HPA)轴受损是最重要的,因为如果不加以诊断,它可能会导致死亡。严重急性呼吸系统综合征冠状病毒2型可能导致原发性和继发性肾上腺功能不全(AI)。AI的临床表现通常是非特异性的,可能归因于感染本身引起的并发症。潜在的发病机制可以通过感染的免疫原性、血管作用或病毒的直接作用来解释。新冠肺炎危重患者的人工智能诊断并不简单。在疾病期间,对基础血清皮质醇水平和刺激测试的临界值缺乏共识。在此,我们回顾了关于新冠肺炎患者HPA轴评估的文献。我们得出的结论是,在治疗新冠肺炎患者时,应始终牢记人工智能的可能性,重复的基础皮质醇测量和促肾上腺皮质激素刺激测试结果可以在诊断过程中指导临床医生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neuroimmunomodulation
Neuroimmunomodulation 医学-免疫学
CiteScore
3.60
自引率
4.20%
发文量
35
审稿时长
>12 weeks
期刊介绍: The rapidly expanding area of research known as neuroimmunomodulation explores the way in which the nervous system interacts with the immune system via neural, hormonal, and paracrine actions. Encompassing both basic and clinical research, ''Neuroimmunomodulation'' reports on all aspects of these interactions. Basic investigations consider all neural and humoral networks from molecular genetics through cell regulation to integrative systems of the body. The journal also aims to clarify the basic mechanisms involved in the pathogenesis of the CNS pathology in AIDS patients and in various neurodegenerative diseases. Although primarily devoted to research articles, timely reviews are published on a regular basis.
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