Hypercortisolism on the background of recovery of COVID-19 (сase report)
Damage to the lung tissue is a predominant complication of the viral disease COVID-19. Recently, there have been complications from other organs, including highly vascularized endocrine glands. Regarding the adrenal glands, there are reports of their damage with a decrease in their function. Сhangin...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Zaslavsky O.Yu.
2022-04-01
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| Series: | Mìžnarodnij Endokrinologìčnij Žurnal |
| Subjects: | |
| Online Access: | https://iej.zaslavsky.com.ua/index.php/journal/article/view/1159 |
| _version_ | 1797854284248776704 |
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| author | V. Kravchenko O. Rakov L.V. Slipachuk |
| author_facet | V. Kravchenko O. Rakov L.V. Slipachuk |
| author_sort | V. Kravchenko |
| collection | DOAJ |
| description | Damage to the lung tissue is a predominant complication of the viral disease COVID-19. Recently, there have been complications from other organs, including highly vascularized endocrine glands. Regarding the adrenal glands, there are reports of their damage with a decrease in their function. Сhanging the function of the adrenal glands (AG) in patients with or after COVID-19 is important. A few adrenal autopsy studies in patients have revealed vascular thrombosis, cortical lipid degeneration, ischemic necrosis, parenchymal infarcts, and other lesions leading to a decrease in AG function. The central mechanism of adrenal dysfunction through hemorrhage and necrosis of the pituitary gland is also possible. This paper presents a rare case of the development of hypercortisolism in a young woman after recovering from COVID-19. Based on high ACTH levels (157 and 122 pg/ml), a negative nocturnal dexamethasone test, and high 24-hour urinary free (daily) cortisol excretion rates, we tentatively suspected Cushing’s disease. Chromogranin A was within the normal range of 21.35 (reference value < 100). Other tests showed an elevated dihydrotestosterone level of 780.6 pg/ml (reference values 24–368 pg/ml). The levels of other anterior pituitary hormones tested were within the normal range. According to clinical guidelines, the drug of choice for the short-term treatment of this disease is steroidogenesis inhibitors — ketoconazole. The effectiveness of such a treatment regimen was previously brought to light by others. In our case, ketoconazole was prescribed at a dose of 400 mg 2 times a day and cabergoline (dostinex) at an initial dose of 1 mg per day. Given the low levels of vitamin D in the blood serum, it was recommended to continue taking vitamin D at a dose of 4000 IU per day. It was recommended to control blood laboratory parameters — serum cortisol, ACTH, AST, ALT, electrolytes, 25(OH)D, blood glucose level after 2 months and decide on further tactics for managing the patient. |
| first_indexed | 2024-04-09T20:03:34Z |
| format | Article |
| id | doaj.art-b02ed7039e74457dbd9cd085d1c6ebd7 |
| institution | Directory Open Access Journal |
| issn | 2224-0721 2307-1427 |
| language | English |
| last_indexed | 2024-04-09T20:03:34Z |
| publishDate | 2022-04-01 |
| publisher | Zaslavsky O.Yu. |
| record_format | Article |
| series | Mìžnarodnij Endokrinologìčnij Žurnal |
| spelling | doaj.art-b02ed7039e74457dbd9cd085d1c6ebd72023-04-02T18:41:08ZengZaslavsky O.Yu.Mìžnarodnij Endokrinologìčnij Žurnal2224-07212307-14272022-04-0118213313710.22141/2224-0721.18.2.2022.11591159Hypercortisolism on the background of recovery of COVID-19 (сase report)V. Kravchenko0O. Rakov1L.V. Slipachuk2State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the NAMS of Ukraine”, Kyiv, UkraineState Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the NAMS of Ukraine”, Kyiv, UkraineBohomolets National Medical University, Kyiv, UkraineDamage to the lung tissue is a predominant complication of the viral disease COVID-19. Recently, there have been complications from other organs, including highly vascularized endocrine glands. Regarding the adrenal glands, there are reports of their damage with a decrease in their function. Сhanging the function of the adrenal glands (AG) in patients with or after COVID-19 is important. A few adrenal autopsy studies in patients have revealed vascular thrombosis, cortical lipid degeneration, ischemic necrosis, parenchymal infarcts, and other lesions leading to a decrease in AG function. The central mechanism of adrenal dysfunction through hemorrhage and necrosis of the pituitary gland is also possible. This paper presents a rare case of the development of hypercortisolism in a young woman after recovering from COVID-19. Based on high ACTH levels (157 and 122 pg/ml), a negative nocturnal dexamethasone test, and high 24-hour urinary free (daily) cortisol excretion rates, we tentatively suspected Cushing’s disease. Chromogranin A was within the normal range of 21.35 (reference value < 100). Other tests showed an elevated dihydrotestosterone level of 780.6 pg/ml (reference values 24–368 pg/ml). The levels of other anterior pituitary hormones tested were within the normal range. According to clinical guidelines, the drug of choice for the short-term treatment of this disease is steroidogenesis inhibitors — ketoconazole. The effectiveness of such a treatment regimen was previously brought to light by others. In our case, ketoconazole was prescribed at a dose of 400 mg 2 times a day and cabergoline (dostinex) at an initial dose of 1 mg per day. Given the low levels of vitamin D in the blood serum, it was recommended to continue taking vitamin D at a dose of 4000 IU per day. It was recommended to control blood laboratory parameters — serum cortisol, ACTH, AST, ALT, electrolytes, 25(OH)D, blood glucose level after 2 months and decide on further tactics for managing the patient.https://iej.zaslavsky.com.ua/index.php/journal/article/view/1159cushing’s syndromehypercortisolismcovid-19treatmentcase report |
| spellingShingle | V. Kravchenko O. Rakov L.V. Slipachuk Hypercortisolism on the background of recovery of COVID-19 (сase report) Mìžnarodnij Endokrinologìčnij Žurnal cushing’s syndrome hypercortisolism covid-19 treatment case report |
| title | Hypercortisolism on the background of recovery of COVID-19 (сase report) |
| title_full | Hypercortisolism on the background of recovery of COVID-19 (сase report) |
| title_fullStr | Hypercortisolism on the background of recovery of COVID-19 (сase report) |
| title_full_unstemmed | Hypercortisolism on the background of recovery of COVID-19 (сase report) |
| title_short | Hypercortisolism on the background of recovery of COVID-19 (сase report) |
| title_sort | hypercortisolism on the background of recovery of covid 19 сase report |
| topic | cushing’s syndrome hypercortisolism covid-19 treatment case report |
| url | https://iej.zaslavsky.com.ua/index.php/journal/article/view/1159 |
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