Clinical characteristics of endocrine disturbances in post-COVID-19 condition, case report with review of literature

Abstract

Post-COVID-19 condition (PCC) is frequently associated with multiple endocrine hormone disturbances, primarily involving the hypothalamic–pituitary–adrenal axis. However, the exact cause remains unclear, particularly concerning whether these symptoms result from hypothalamus damage. This study reports on the clinical characteristics and examination methods of five patients exhibiting multiple endocrine disorders during PCC following SARS-CoV-2 infections, as well as the corresponding treatment strategies. Insulin tolerance test (ITT), arginine stimulation test, rapid adrenocorticotropic hormone (ACTH) stimulation test, and supine–standing test were used to evaluate endocrine hormone disturbances. Magnetic resonance imaging of the pituitary and computed tomography of the adrenal gland on one patient were performed to reveal the pathology. All five patients had hypothalamic syndrome with secondary adrenal insufficiency, growth hormone (GH) deficiency, and secondary hyperaldosteronism. Treatment included ACTH injection, recombinant human GH injection, and/or oral administration of synthetic glucocorticoids (prednisone acetate or methylprednisolone) and mineralocorticoid receptor antagonist finerenone. Remarkable improvement was observed within one week for all patients. To assess disorders in the hypothalamic–pituitary–§adrenal axis, dynamic endocrine testing is recommended. Upon confirmation of a diagnosis, timely supplementation of ACTH, glucocorticoids, GH, and aldosterone antagonists can yield remarkable therapeutic outcomes.