{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:32:10Z","timestamp":1792369930749,"version":"4.4.0"},"reference-count":42,"publisher":"Bioscientifica","issue":"9","license":[{"start":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T00:00:00Z","timestamp":1721606400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["ec.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,7,22]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We studied the temporal course of hypothalamic\u2013pituitary\u2013adrenal (HPA) dysfunction in patients with coronavirus disease 2019 (COVID-19).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Three hundred and two patients (median age 54 years (interquartile range (IQR) 42\u201364), 76% males) were recruited. The HPA axis was evaluated by morning cortisol and adrenocorticotrophic hormone (ACTH) at admission (\n                      <jats:italic>n<\/jats:italic>\n                      = 232). Adrenal insufficiency (AI) during acute illness was defined using a morning cortisol &lt;83 nmol\/L. AI at 12 months follow-up was defined using a peak cortisol &lt;406 nmol\/L in the ACTH stimulation test (APST) (\n                      <jats:italic>n<\/jats:italic>\n                      = 90). Those with AI at 12 months were further assessed by APST every 6 months for recovery of hypoadrenalism.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median morning cortisol and ACTH levels during COVID-19 were 295 (IQR 133\u2013460) nmol\/L and 3.9 (0.8\u20136.9) pmol\/L, respectively. AI was present in 33 (14%) patients; ACTH was elevated in three and low or inappropriately normal in the rest 30 patients. At 12 months, AI was seen in 13% (12\/90) patients, with all cases being hypothalamic\u2013pituitary in origin; five (42%) of them had not met the diagnostic criteria for AI during COVID-19. AI diagnosed at admission persisted at 12 months in seven patients and recovered in seven; the remaining 19 patients were lost to follow-up. The presence of AI at 12 months was independent of severity and steroid use during COVID-19. A morning cortisol &lt;138 nmol\/L during COVID-19 predicted the presence of AI at 12 months. All patients showed recovery of the HPA axis in the ensuing 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Central AI was common during acute COVID-19 and at 12 months of follow-up. AI can be late onset, developing after recovery from COVID-19, and was transient in nature.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/ec-24-0086","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T06:56:23Z","timestamp":1721804183000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-10","source":"Crossref","is-referenced-by-count":7,"title":["Reversible central adrenal insufficiency in survivors of COVID-19: results from a 24-month longitudinal study"],"prefix":"10.1530","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6246-3519","authenticated-orcid":true,"given":"Saroj Kumar","family":"Sahoo","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India"},{"name":"Division of Endocrinology, Mid and South Essex NHS Trust, Broomfield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2658-4505","authenticated-orcid":true,"given":"Jayakrishnan C","family":"Menon","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7709-9200","authenticated-orcid":true,"given":"Nidhi","family":"Tripathy","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monalisa","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Liver Intensive Care Unit, King\u2019s College Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3275-6673","authenticated-orcid":true,"given":"Subhash","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Cell","first-page":"271","article-title":"SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor","volume":"181","author":"Hoffmann","year":"2020","unstructured":"Hoffmann MKleine-Weber HSchroeder SKr\u00fcger NHerrler TErichsen SSchiergens TSHerrler GWu NHNitsche A, et al.SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. 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