tetano
Editor, Senior Moderator
Endocrine
. 2021 Mar 13.
doi: 10.1007/s12020-021-02674-5. Online ahead of print.
Clinical course and outcome of patients with ACTH-dependent Cushing's syndrome infected with novel coronavirus disease-19 (COVID-19): case presentations
Zhanna Belaya[SUP] 1 [/SUP], Olga Golounina[SUP] 2 [/SUP], Galina Melnichenko[SUP] 3 [/SUP], Natalia Tarbaeva[SUP] 3 [/SUP], Evgenia Pashkova[SUP] 4 [/SUP], Maxim Gorokhov[SUP] 3 [/SUP], Viktor Kalashnikov[SUP] 3 [/SUP], Larisa Dzeranova[SUP] 3 [/SUP], Valentin Fadeev[SUP] 2 [/SUP], Pavel Volchkov[SUP] 3 5 [/SUP], Ivan Dedov[SUP] 3 [/SUP]
Affiliations
Abstract
Objective: To analyze the clinical presentations of patients with endogenous Cushing's syndrome (CS) affected by Coronavirus disease-19 (COVID-19).
Materials and methods: Patients who were referred to our clinic with active CS from 31st March to 15th May 2020 were screened for COVID-19 using real-time reverse transcriptase-polymerase chain reaction (RT-PCR). Late-night serum cortisol (64-327 nmol/L), late-night salivary cortisol (LNSC) (0.5-9.4 nmol/L), or 24-h urinary free cortisol (24 hUFC) (100-379 nmol/24 h) were measured by electrochemiluminescence immunoassay.
Results: Among 22 patients with active CS we found three cases affected by COVID-19. Nonspecific inflammation markers were within the reference range or slightly elevated in these patients. A 71-year-old woman with newly diagnosed CS (late-night serum cortisol >1750 nmol/L, LNSC 908.6 nmol/L) developed dyspnea as an only symptom and died from bilateral polysegmantal hemorrhagic pneumonia 7 days later. A 38-year-old woman with a 5-year medical history of active Cushing's disease (CD) (late-night serum cortisol 581.3 nmol/L, 24 hUFC 959.7 nmol/24-h) suffered from dyspnea, cough, fever (39.3 ?C) and chest pain. Oxygen therapy, antibiotics and symptomatic treatments lead to full recovery 24 days later. A 66-year-old woman with a 4-year medical history of mild CD (late-night serum cortisol 603.4 nmol/L, LNSC 10.03 nmol/L) tested positive for COVID-19 in routine screening and remained asymptomatic.
Conclusions: The outcome of COVID-19 in patients with CS depends on the severity of hypercortisolism. Thus, severe hypercortisolism is a warning sign that CS affected by COVID-19 could require emergency care despite a lack of clinical presentations and low inflammation biomarkers.
Keywords: ACTH-dependent Cushing?s syndrome; COVID-19; Cushing?s disease; Pneumonia; SARS-CoV-2.
. 2021 Mar 13.
doi: 10.1007/s12020-021-02674-5. Online ahead of print.
Clinical course and outcome of patients with ACTH-dependent Cushing's syndrome infected with novel coronavirus disease-19 (COVID-19): case presentations
Zhanna Belaya[SUP] 1 [/SUP], Olga Golounina[SUP] 2 [/SUP], Galina Melnichenko[SUP] 3 [/SUP], Natalia Tarbaeva[SUP] 3 [/SUP], Evgenia Pashkova[SUP] 4 [/SUP], Maxim Gorokhov[SUP] 3 [/SUP], Viktor Kalashnikov[SUP] 3 [/SUP], Larisa Dzeranova[SUP] 3 [/SUP], Valentin Fadeev[SUP] 2 [/SUP], Pavel Volchkov[SUP] 3 5 [/SUP], Ivan Dedov[SUP] 3 [/SUP]
Affiliations
- PMID: 33713312
- DOI: 10.1007/s12020-021-02674-5
Abstract
Objective: To analyze the clinical presentations of patients with endogenous Cushing's syndrome (CS) affected by Coronavirus disease-19 (COVID-19).
Materials and methods: Patients who were referred to our clinic with active CS from 31st March to 15th May 2020 were screened for COVID-19 using real-time reverse transcriptase-polymerase chain reaction (RT-PCR). Late-night serum cortisol (64-327 nmol/L), late-night salivary cortisol (LNSC) (0.5-9.4 nmol/L), or 24-h urinary free cortisol (24 hUFC) (100-379 nmol/24 h) were measured by electrochemiluminescence immunoassay.
Results: Among 22 patients with active CS we found three cases affected by COVID-19. Nonspecific inflammation markers were within the reference range or slightly elevated in these patients. A 71-year-old woman with newly diagnosed CS (late-night serum cortisol >1750 nmol/L, LNSC 908.6 nmol/L) developed dyspnea as an only symptom and died from bilateral polysegmantal hemorrhagic pneumonia 7 days later. A 38-year-old woman with a 5-year medical history of active Cushing's disease (CD) (late-night serum cortisol 581.3 nmol/L, 24 hUFC 959.7 nmol/24-h) suffered from dyspnea, cough, fever (39.3 ?C) and chest pain. Oxygen therapy, antibiotics and symptomatic treatments lead to full recovery 24 days later. A 66-year-old woman with a 4-year medical history of mild CD (late-night serum cortisol 603.4 nmol/L, LNSC 10.03 nmol/L) tested positive for COVID-19 in routine screening and remained asymptomatic.
Conclusions: The outcome of COVID-19 in patients with CS depends on the severity of hypercortisolism. Thus, severe hypercortisolism is a warning sign that CS affected by COVID-19 could require emergency care despite a lack of clinical presentations and low inflammation biomarkers.
Keywords: ACTH-dependent Cushing?s syndrome; COVID-19; Cushing?s disease; Pneumonia; SARS-CoV-2.