PITUITARY FUNCTIONS AFTER RECOVERY FROM COVID-19

Abstract

Context: Injury and functional disorders in pituitary gland after COVID-19 still need elucidation.

Objective: To investigate pituitary functions, particularly hypothalamic pituitary adrenal (HPA) axis after COVID-19 infection.

Methods: This study was conducted at a university hospital between May and October 2021. Patients who had COVID-19, were enrolled as study group, three months after recovery. Participants who do not have COVID-19 diagnosis, with similar characteristics were included as control group. Blood samples were taken on the morning at 08 AM. Adrenal stimulation test was performed with 1 µg of ACTH (Synacthen).

Results: The study group included 50 patients and control group was 49 cases. One (2%) out of the 50 patients with 8 a.m. serum cortisol below 5 µg/dL. Low serum ACTH levels were detected in 7 (14%) participants in patient group. Stimulation with 1 µg of ACTH (Synacthen) test was performed for 2 (4%) of 50 patients with serum cortisol below 10 µg/dL. Both patients achieved a peak cortisol of over 12.5 µg/dL after stimulation. Standard deviation (SD) score for insulin like growh factor-1 (IGF-1) was lower than -2 SD for age and gender in 7 (14%) patients. TSH levels was mildly increased in five (10%) patients. There was no significant difference in baseline pituitary hormone levels in study and control groups.

Conclusion: Basal pituitary hormone levels and HPA axes were found to be preserved and competently functioning in patients who experienced mild/moderate COVID-19. However, symptoms observed after COVID-19 episode were evident in substantial amount of patients in this study and these symptoms were not associated with changes in pituitary gland function.

Keywords: Adrenal insufficiency; COVID-19; cosyntropin; hypothalamo-pituitary-adrenal axis; thyroid.