TY - JOUR
TI - Alterations in cortisol and interleukin-6 secretion in patients with
COVID-19 suggestive of neuroendocrine-immune adaptations
AU - Yavropoulou, Maria P.
AU - Filippa, Maria G.
AU - Mantzou, Aimilia and
AU - Ntziora, Fotinie
AU - Mylona, Maria
AU - Tektonidou, Maria G. and
AU - Vlachogiannis, Nikolaos I.
AU - Paraskevis, Dimitrios
AU - Kaltsas,
AU - Gregory A.
AU - Chrousos, George P.
AU - Sfikakis, Petros P.
JO - Endocrine Development
PY - 2022
VL - 75
TODO - 2
SP - 317-327
PB - Springer-Verlag
SN - null
TODO - 10.1007/s12020-021-02968-8
TODO - Diurnal salivary cortisol; Diurnal salivary dehydroepiandrosterone;
Aldosterone; Adrenocorticotropin; SARS-CoV-2
TODO - 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.
ER -