SFEBES2022 Oral Communications Adrenal and Cardiovascular (6 abstracts)
Plasma steroid concentrations reflect disease severity during acute illness but not recovery after hospitalisation with COVID-19
Kerri Devine 1 , Brian R Walker 2 , Natalie ZM Homer 1 , Peter JM Openshaw 3 , J. Kenneth Baillie 1 , Ruth Andrew 1 , Louise V Wain 4 , Malcolm G Semple 5 & Rebecca M Reynolds 1
1University of Edinburgh, Edinburgh, United Kingdom; 2Newcastle University, Newcastle, United Kingdom; 3Imperial College London, London, United Kingdom; 4University of Leicester, Leicester, United Kingdom; 5University of Liverpool, Liverpool, United Kingdom
Background: Endocrine systems are known to be disrupted in acute illness, and we previously demonstrated that plasma steroid concentrations correlated with severity in patients hospitalised with COVID-19. Given their similarity to some clinical hormone deficiencies, we hypothesised that ‘long-COVID’ symptoms may be related to ongoing endocrine dysfunction.
Methods: Plasma steroids, precursors and metabolites were quantified by LCMS/MS in multi-centre cohorts of adults hospitalized with COVID-19 (ISARIC/WHO CCP-UK study), and studied post-discharge (PHOSP-COVID study). These were compared against disease severity (WHO ordinal scale) and validated symptom scores. Results are median (IQR)/geometric mean (geometric SD).
Results: Acute disease (as previously presented) Among 239 adults (67% male; age 63(52-73.5) yrs; mortality 19.7%), those with fatal disease had higher cortisol [753.3 (1.6) vs 429.2 (1.7) nmol/l, P<0.001] and (in males) lower testosterone concentrations (1.2 (2.2) vs 6.9 (1.9) nmol/l, P<0.001) than patients not requiring oxygen supplementation.
Recovery: Among 196 adults (63% male; age 58(49-65) yrs; 164(121-191) days post-discharge), cortisol concentration [275.6 (1.5) nmol/l] did not differ with in-hospital severity (P=0.95), or steroid therapy (P=0.61). There was no correlation between plasma cortisol and perception of recovery (P=0.41), or patient-reported symptoms of fatigue (FACIT-F score, P=0.46), depression (PHQ-9 score, P=0.21), anxiety (GAD-7 score, P=0.21), post-traumatic stress (PCL-5 score, P=0.11) or breathlessness (Dyspnoea-12 score, P=0.12). Similarly, male testosterone concentration of 12.8 (1.5) nmol/l was unrelated to in-hospital severity (P=0.21), perception of recovery (P=0.71) or symptom scores (P=0.34, P=0.40, P=0.51, P=0.68, P=0.21 respectively, ordered as above).
Conclusions: Circulating steroids in patients hospitalized with COVID-19 are representative of the acute illness response, with a marked rise in cortisol and fall in male testosterone. This relationship disappears within 6 months from discharge, and we did not identify a link between glucocorticoid or male androgen concentrations and ongoing symptoms in this cohort.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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