@article{3034132,
    title = "Alterations in cortisol and interleukin-6 secretion in patients with
COVID-19 suggestive of neuroendocrine-immune adaptations",
    author = "Yavropoulou, Maria P. and Filippa, Maria G. and Mantzou, Aimilia and and Ntziora, Fotinie and Mylona, Maria and Tektonidou, Maria G. and and Vlachogiannis, Nikolaos I. and Paraskevis, Dimitrios and Kaltsas, and Gregory A. and Chrousos, George P. and Sfikakis, Petros P.",
    journal = "Endocrine Development",
    year = "2022",
    volume = "75",
    number = "2",
    pages = "317-327",
    publisher = "Springer-Verlag",
    doi = "10.1007/s12020-021-02968-8",
    keywords = "Diurnal salivary cortisol; Diurnal salivary dehydroepiandrosterone;
Aldosterone; Adrenocorticotropin; SARS-CoV-2",
    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) mu g/dl, p <
0.001 and 0.183 (0.090, 0.834) vs. 0.054 (0.054, 0.332) mu g/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 (rho = 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 glucocorticoidsecreting adrenal zonafasciculata without
influencing the secretion of DHEA and aldosterone."
}