Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun 22:13:889928.
doi: 10.3389/fendo.2022.889928. eCollection 2022.

Successful Immunomodulatory Treatment of COVID-19 in a Patient With Severe ACTH-Dependent Cushing's Syndrome: A Case Report and Review of Literature

Bojana Popovic  1   2   3 , Aleksandra Radovanovic Spurnic  1   3   4 , Jelena Velickovic  1   3   5 , Aleksandra Plavsic  1   3   6 , Milica Jecmenica-Lukic  1   3   7 , Tijana Glisic  1   3   8 , Dusan Ilic  1   2 , Danka Jeremic  1   2   3 , Jelena Vratonjic  1 , Vladimir Samardzic  9 , Zoran Gluvic  3   9 , Tatjana Adzic-Vukicevic  1   3   10
Affiliations
Review

Successful Immunomodulatory Treatment of COVID-19 in a Patient With Severe ACTH-Dependent Cushing's Syndrome: A Case Report and Review of Literature

Bojana Popovic et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: Patients with Cushing's syndrome (CS) represent a highly sensitive group during corona virus disease 2019 (COVID-19) pandemic. The effect of multiple comorbidities and immune system supression make the clinical picture complicated and treatment challenging.

Case report: A 70-year-old female was admitted to a covid hospital with a severe form of COVID-19 pneumonia that required oxygen supplementation. Prior to her admission to the hospital she was diagnosed with adrenocorticotropic hormone (ACTH)-dependent CS, and the treatment of hypercortisolism had not been started yet. Since the patient's condition was quickly deteriorating, and with presumend immmune system supression due to CS, we decided on treatement with intraveonus immunoglobulins (IVIg) that enabled quick onset of immunomodulatory effect. All comorbidities were treated with standard of care. The patient's condition quickly stabilized with no direct side effects of a given treatment.

Conclusion: Treatment of COVID-19 in patients with CS faces many challenges due to the complexity of comorbidity effects, immunosupression and potential interactions of available medications both for treatment of COVID-19 and CS. So far, there are no guidelines for treatment of COVID-19 in patients with active CS. It is our opinion that immunomodulating therapies like IVIg might be an effective and safe treatment modality in this particularly fragile group of patients.

Keywords: COVID-19; Cushing’s syndrome; IVIg; hypercortisolism; immunomodulation; immunosuppression.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Hu J, Wang Y. The Clinical Characteristics and Risk Factors of Severe COVID-19. Gerontology (2021) 67(3):255–66. doi: 10.1159/000513400 - DOI - PMC - PubMed
    1. Valassi E, Tabarin A, Brue T, Feelders RA, Reincke M, Netea-Maier R, et al. . High Mortality Within 90 Days of Diagnosis in Patients With Cushing's Syndrome: Results From the ERCUSYN Registry. Eur J Endocrinol (2019) 181(5):461–72. doi: 10.1530/EJE-19-0464 - DOI - PubMed
    1. Hasenmajer V, Sbardella E, Sciarra F, Minnetti M, Isidori AM, Venneri MA. The Immune System in Cushing's Syndrome. Trends Endocrinol Metab (2020) 31(9):655–69. doi: 10.1016/j.tem.2020.04.004 - DOI - PubMed
    1. Pivonello R, Isidori AM, De Martino MC, Newell-Price J, Biller BM, Colao A. Complications of Cushing's Syndrome: State of the Art. Lancet Diabetes Endocrinol (2016) 4(7):611–29. doi: 10.1016/S2213-8587(16)00086-3 - DOI - PubMed
    1. Martins-Filho PR, Tavares CSS, Santos VS. Factors Associated With Mortality in Patients With COVID-19. A Quantitative Evidence Synthesis of Clinical and Laboratory Data. Eur J Intern Med (2020) 76:97–9. doi: 10.1016/j.ejim.2020.04.043 - DOI - PMC - PubMed

Substances