tetano
Editor, Senior Moderator
Endocrine
. 2022 Jan 18.
doi: 10.1007/s12020-021-02968-8. Online ahead of print.
Alterations in cortisol and interleukin-6 secretion in patients with COVID-19 suggestive of neuroendocrine-immune adaptations
Maria P Yavropoulou[SUP] 1 [/SUP], Maria G Filippa[SUP] 2 [/SUP], Aimilia Mantzou[SUP] 3 [/SUP], Fotinie Ntziora[SUP] 2 [/SUP], Maria Mylona[SUP] 2 [/SUP], Maria G Tektonidou[SUP] 2 [/SUP], Nikolaos I Vlachogiannis[SUP] 2 [/SUP], Dimitrios Paraskevis[SUP] 4 [/SUP], Gregory A Kaltsas[SUP] 2 [/SUP], George P Chrousos[SUP] #[/SUP][SUP] 5 [/SUP], Petros P Sfikakis[SUP] #[/SUP][SUP] 2 [/SUP]
Affiliations
Abstract
Purpose: The beneficial effect of glucocorticoids in coronavirus disease (COVID-19) is established, but whether adrenal cortisol secretion is impaired in COVID-19 is not fully elucidated. In this case-control study, we investigated the diurnal free bioavailable salivary cortisol secretion in COVID-19 patients.
Methods: Fifty-two consecutive COVID-19 patients-before dexamethasone treatment in cases required-recruited between April 15 to June 15, 2021, (NCT04988269) at Laikon Athens University-Hospital, and 33 healthy age- and sex-matched controls were included. Diurnal salivary cortisol (8 a.m., 12, 6, and 10 p.m.), plasma adrenocorticotropin (ACTH) and aldosterone, and serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels were assessed. Diurnal salivary dehydroepiandrosterone (DHEA) and IL-6 were also assessed in subgroups of patients.
Results: Median CRP and IL-6 measurements were about sixfold higher in patients than controls (both p < 0.001) Morning salivary cortisol levels did not differ between the two groups, but patients exhibited higher median levels of evening and nocturnal salivary cortisol compared to controls [0.391 (0.054, 0663) vs. 0.081 (0.054, 0.243) μg/dl, p < 0.001 and 0.183 (0.090, 0.834) vs. 0.054 (0.054, 0.332) μg/dl, p < 0.001, respectively], resulting in higher time-integrated area under the curve (AUC) (4.81 ± 2.46 vs. 2.75 ± 0.810, respectively, p < 0.001). Circulating ACTH, DHEA, and aldosterone levels were similar in patients and controls. Serum IL-6, but not ACTH levels, was strongly correlated with nocturnal cortisol salivary levels (ρ = 0.555, p < 0.001) in patients.
Conclusions: Increased evening and nocturnal but not morning cortisol secretion may occur in even clinically mild COVID-19. In the context of acute viral infection (COVID-19), IL-6 may partially replace ACTH as a stimulus of the glucocorticoid-secreting adrenal zona-fasciculata without influencing the secretion of DHEA and aldosterone.
Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04988269?term=yavropoulou&draw=2&rank=3 (NCT04988269).
Keywords: Adrenocorticotropin; Aldosterone; Diurnal salivary cortisol; Diurnal salivary dehydroepiandrosterone; SARS-CoV-2.
. 2022 Jan 18.
doi: 10.1007/s12020-021-02968-8. Online ahead of print.
Alterations in cortisol and interleukin-6 secretion in patients with COVID-19 suggestive of neuroendocrine-immune adaptations
Maria P Yavropoulou[SUP] 1 [/SUP], Maria G Filippa[SUP] 2 [/SUP], Aimilia Mantzou[SUP] 3 [/SUP], Fotinie Ntziora[SUP] 2 [/SUP], Maria Mylona[SUP] 2 [/SUP], Maria G Tektonidou[SUP] 2 [/SUP], Nikolaos I Vlachogiannis[SUP] 2 [/SUP], Dimitrios Paraskevis[SUP] 4 [/SUP], Gregory A Kaltsas[SUP] 2 [/SUP], George P Chrousos[SUP] #[/SUP][SUP] 5 [/SUP], Petros P Sfikakis[SUP] #[/SUP][SUP] 2 [/SUP]
Affiliations
- PMID: 35043384
- DOI: 10.1007/s12020-021-02968-8
Abstract
Purpose: The beneficial effect of glucocorticoids in coronavirus disease (COVID-19) is established, but whether adrenal cortisol secretion is impaired in COVID-19 is not fully elucidated. In this case-control study, we investigated the diurnal free bioavailable salivary cortisol secretion in COVID-19 patients.
Methods: Fifty-two consecutive COVID-19 patients-before dexamethasone treatment in cases required-recruited between April 15 to June 15, 2021, (NCT04988269) at Laikon Athens University-Hospital, and 33 healthy age- and sex-matched controls were included. Diurnal salivary cortisol (8 a.m., 12, 6, and 10 p.m.), plasma adrenocorticotropin (ACTH) and aldosterone, and serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels were assessed. Diurnal salivary dehydroepiandrosterone (DHEA) and IL-6 were also assessed in subgroups of patients.
Results: Median CRP and IL-6 measurements were about sixfold higher in patients than controls (both p < 0.001) Morning salivary cortisol levels did not differ between the two groups, but patients exhibited higher median levels of evening and nocturnal salivary cortisol compared to controls [0.391 (0.054, 0663) vs. 0.081 (0.054, 0.243) μg/dl, p < 0.001 and 0.183 (0.090, 0.834) vs. 0.054 (0.054, 0.332) μg/dl, p < 0.001, respectively], resulting in higher time-integrated area under the curve (AUC) (4.81 ± 2.46 vs. 2.75 ± 0.810, respectively, p < 0.001). Circulating ACTH, DHEA, and aldosterone levels were similar in patients and controls. Serum IL-6, but not ACTH levels, was strongly correlated with nocturnal cortisol salivary levels (ρ = 0.555, p < 0.001) in patients.
Conclusions: Increased evening and nocturnal but not morning cortisol secretion may occur in even clinically mild COVID-19. In the context of acute viral infection (COVID-19), IL-6 may partially replace ACTH as a stimulus of the glucocorticoid-secreting adrenal zona-fasciculata without influencing the secretion of DHEA and aldosterone.
Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04988269?term=yavropoulou&draw=2&rank=3 (NCT04988269).
Keywords: Adrenocorticotropin; Aldosterone; Diurnal salivary cortisol; Diurnal salivary dehydroepiandrosterone; SARS-CoV-2.