Possibility of endocrine dysfunction in post coronavirus disease 2019 (COVID-19) condition

Dear Editor;

We recently read, with great interest, the case report of hypopituitarism and hypogonadism induced by coronavirus disease 2019 (COVID-19) authored by Yoshimura et al., published in Endocr J [1]. The authors concluded that the possibility of endocrine dysfunction should be considered if COVID-19 symptoms persist for an extended period. Persistent symptoms after COVID-19, defined as post COVID-19 condition (PCC) by the World Health Organization, affect many patients. The pathophysiology and underlying mechanism of PCC have yet to be elucidated. PCC has become a global problem; therefore, we consider it very important to accumulate and share such cases.

In this context, we established a COVID-19 aftercare clinic and engaged in patient care and clinical research on PCC [2]. In the clinical aspect, we previously reported that patients with PCC experiencing general fatigue, the most common symptom of PCC, exhibited relatively lower levels of serum GH. Moreover, clinically severe acute COVID-19 was associated with impaired secretion of ACTH and thyroid hormone in such patients with PCC [3]. These results showed some similarities with the endocrine characteristics of the reported case by Yoshimura et al., which showed transient deficiencies of GH and ACTH that lasted for more than a year [1], implying that the acute changes in the hypothalamic-pituitary-adrenal axis and GH-insulin-like growth factor-1 axis may be prolonged for a certain period. Yoshimura et al. reported that the accompanying hypogonadism persisted into the chronic phase of COVID-19, and in this regard, our study suggested the possibility of underlying symptomatic late-onset hypogonadism (LOH) in patients with PCC [4]. Moreover, it was also consistent with our reported case, in which both gonadal and central factors were involved in the development of LOH in a male patient with PCC [5].

Considering these findings, endocrine dysfunction may be, at least in part, involved in the background of chronic COVID-19 pathogenesis, as well as in PCC. Therefore, appropriate examinations should be performed to avoid overlooking these medically explained pathologies under PCC.

Acknowledgment

This work was supported by JSPS KAKENHI Grant Number JP22K20927.

Disclosure

None of the authors have any potential conflicts of interest associated with this research.

References

• 1   Yoshimura  K,  Yamamoto  M,  Inoue  T,  Fukuoka  H,  Iida  K, et al. (2022) Coexistence of growth hormone, adrenocorticotropic hormone, and testosterone deficiency associated with coronavirus disease 2019: a case followed up for 15 months. Endocr J doi: 10.1507/endocrj.EJ22-0108. Online ahead of print.
• 2   Otsuka  Y,  Tokumasu  K,  Nakano  Y,  Honda  H,  Sakurada  Y, et al. (2021) Clinical characteristics of Japanese patients who visited a COVID-19 aftercare clinic for post-acute sequelae of COVID-19/Long COVID. Cureus 13: e18568.
• 3   Sunada  N,  Honda  H,  Nakano  Y,  Yamamoto  K,  Tokumasu  K, et al. (2022) Hormonal trends in patients suffering from long COVID symptoms. Endocr J doi: 10.1507/endocrj.EJ22-0093. Online ahead of print.
• 4   Yamamoto  Y,  Otsuka  Y,  Sunada  N,  Tokumasu  K,  Nakano  Y, et al. (2022) Detection of male hypogonadism in patients with post COVID-19 condition. J Clin Med 11: 1955.
• 5   Soejima  Y,  Otsuka  Y,  Tokumasu  K,  Nakano  Y,  Harada  K, et al. (2022) Late-onset hypogonadism in a male patient with long COVID diagnosed by exclusion of ME/CFS. Medicina (Kaunas) 58: 536.