{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:23Z","timestamp":1784557043342,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T00:00:00Z","timestamp":1643673600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>The pandemic caused by severe acute respiratory syndrome coronavirus 2 is of an unprecedented magnitude and has made it challenging to properly treat patients with urgent or rare endocrine disorders. Little is known about the risk of coronavirus disease 2019 (COVID-19) in patients with rare endocrine malignancies, such as pituitary carcinoma. We describe the case of a 43-year-old patient with adrenocorticotrophic hormone-secreting pituitary carcinoma who developed a severe COVID-19 infection. He had stabilized Cushing\u2019s disease after multiple lines of treatment and was currently receiving maintenance immunotherapy with nivolumab (240 mg every 2 weeks) and steroidogenesis inhibition with ketoconazole (800 mg daily). On admission, he was urgently intubated for respiratory exhaustion. Supplementation of corticosteroid requirements consisted of high-dose dexamethasone, in analogy with the RECOVERY trial, followed by the reintroduction of ketoconazole under the coverage of a hydrocortisone stress regimen, which was continued at a dose depending on the current level of stress. He had a prolonged and complicated stay at the intensive care unit but was eventually discharged and able to continue his rehabilitation. The case points out that multiple risk factors for severe COVID-19 are present in patients with Cushing\u2019s syndrome. \u2018Block-replacement\u2019 therapy with suppression of endogenous steroidogenesis and supplementation of corticosteroid requirements might be preferred in this patient population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Comorbidities for severe coronavirus disease 2019 (COVID-19) are frequently present in patients with Cushing\u2019s syndrome.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u2018Block-replacement\u2019 with suppression of endogenous steroidogenesis and supplementation of corticosteroid requirements might be preferred to reduce the need for biochemical monitoring and avoid adrenal insufficiency.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>The optimal corticosteroid dose\/choice for COVID-19 is unclear, especially in patients with endogenous glucocorticoid excess.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>First-line surgery vs initial disease control with steroidogenesis inhibitors for Cushing\u2019s disease should be discussed depending on the current healthcare situation.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-21-0182","type":"journal-article","created":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T05:37:48Z","timestamp":1646113068000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":5,"title":["COVID-19 and Cushing\u2019s disease in a patient with ACTH-secreting pituitary carcinoma"],"prefix":"10.1530","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3906-264X","authenticated-orcid":true,"given":"J M K","family":"de Filette","sequence":"first","affiliation":[{"name":"Department of Endocrinology, University Hospital Brussels (VUB), Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastiaan","family":"Sol","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospital Brussels (VUB), Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil","family":"Awada","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University Hospital Brussels (VUB), Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corina E","family":"Andreescu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospital Brussels (VUB), Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Unuane","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospital Brussels (VUB), Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandrine","family":"Aspeslagh","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University Hospital Brussels (VUB), Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Poelaert","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, University Hospital Brussels (VUB), Brussels, Belgium"},{"name":"Department of Anesthesiology and Perioperative Medicine, University Hospital Brussels (VUB), Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert","family":"Bravenboer","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospital Brussels (VUB), Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Allergy","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1111\/all.14657","article-title":"Risk factors for severe and critically ill COVID-19 patients: a review","volume":"76","author":"Gao","year":"2021","unstructured":"Gao Y-DDing MDong XZhang J-JKursat Azkur AAzkur DGan HSun Y-LFu WLi W, Risk factors for severe and critically ill COVID-19 patients: a review. 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