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. 2024 Jan 11;8(3):bvae003.
doi: 10.1210/jendso/bvae003. eCollection 2024 Jan 16.

Explaining Long COVID: A Pioneer Cross-Sectional Study Supporting the Endocrine Hypothesis

Taieb Ach  1   2   3 , Nassim Ben Haj Slama  1   2 , Asma Gorchane  1   2 , Asma Ben Abdelkrim  1   2 , Meriem Garma  2   4 , Nadia Ben Lasfar  2   4 , Foued Bellazreg  2   4 , Widéd Debbabi  2   5 , Wissem Hachfi  2   4 , Molka Chadli Chaieb  1   2 , Monia Zaouali  1   2   3 , Amel Letaief  2   4 , Koussay Ach  1   2
Affiliations

Explaining Long COVID: A Pioneer Cross-Sectional Study Supporting the Endocrine Hypothesis

Taieb Ach et al. J Endocr Soc. .

Abstract

Context: In some patients, symptoms may persist after COVID-19, defined as long COVID. Its pathogenesis is still debated and many hypotheses have been raised.

Objective: Our primary objective was to evaluate the corticotroph and somatotroph functions of patients previously infected with SARS-CoV-2 and experiencing post-COVID-19 syndrome to detect any deficiencies that may explain long COVID.

Methods: A cross-sectional study was conducted including patients who had previously contracted SARS-CoV-2 with a postinfection period of 3 months or less to 15 months, divided into 2 groups. The first group (G1) comprised fully recovered patients, while the second group (G2) included patients experiencing long COVID. The primary outcome was the comparison of corticotroph and somatotroph functions.

Results: A total of 64 patients were divided into 2 groups, each consisting of 32 patients. G2 exhibited more frequently anterior pituitary deficits compared to G1 (P = .045): for the corticotroph axis (G1: 6.3% vs G2: 28.1%) and for the somatotroph axis (G1: 31.3% vs G2: 59.4%). Baseline cortisol level was significantly lower in G2 (G1: 13.37 µg/dL vs G2: 11.59 µg/dL) (P = .045). The peak cortisol level was also lower in G2 (G1: 23.60 µg/dL vs G2: 19.14 µg/dL) (P = .01). For the somatotroph axis, the insulin growth factor-1 level was lower in G2 (G1: 146.03 ng/mL vs G2: 132.25 ng/mL) (P = .369). The peak growth hormone level was also lower in G2 (G1: 4.82 ng/mL vs G2: 2.89 ng/mL) (P = .041).

Conclusion: The results showed that long COVID patients in our cohort were more likely to have anterior pituitary deficiencies. The endocrine hypothesis involving anterior pituitary insufficiency can be considered to explain long COVID.

Keywords: COVID-19; GH deficiency; SARS-CoV-2; central adrenal insufficiency; hypopituitarism; insulin tolerance test.

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Figures

Figure 1.
Figure 1.
Long COVID symptoms in post-COVID syndrome patients.
Figure 2.
Figure 2.
Mean cortisol level for each time in both groups during the insulin tolerance test.
Figure 3.
Figure 3.
Mean growth hormone (GH) level for each time in both groups during the insulin tolerance test.
See this image and copyright information in PMC

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