Cushing Disease with COVID-19: Protective or Dangerous?

Sahin Alak Zehra Yagmur; Pinar Uzgec Guller; Yaşar Mustafa Burak; Metin Guclu; Fatih Aydemir; Sinem KIYICI

doi:10.1530/endoabs.81.EP813

Introduction: Coronavirus disease-19 (COVID-19) pandemic renders high morbidity and mortality. Glucocorticoid excess is characterized by increased susceptibility to infections due to impairment of the innate and adaptive immune system. Manifestations of Cushing disease (CD) including diabetes mellitus (DM), hypertension, and obesity are risk factors for severe COVID-19 disease. We present three CD patients with different clinical courses of COVID-19. The patients’ general characteristics are summarized in table 1.

Case-1: The patient was a 27-year-old woman with recurrent CD after transsphenoidal surgery. She had DM, hypertension, and obesity. She tested positive for SARS-CoV-2 with dyspnea, cough, chest pain, and fever. She hospitalized at intensive care unit (ICU). A CT scan showed bilateral diffuse ground-lass opacities of both lungs. Significant clinical improvement was achieved on the 13th day of ICU. She discharged from the hospital on 17th day.

Case-2: A 23-year-old woman was diagnosed with CD recently. She had obesity. The COVID-19 nasopharyngeal PCR was positive during preoperative evaluation. Lung involvement wasn’t observed. She survived the COVID-19 disease without symptoms.

Case-3: A 55-year-old woman with CD had a transsphenoidal surgery 2 months ago. She had DM and obesity. She was admitted to our clinic with adrenal insufficiency. She tested positive for SARS-CoV-2 with cough and shortness of the breath. A CT scan showed bilateral pleural effusion and bilateral diffuse ground-glass opacities. She died on the 18th day while treated in ICU.

Table 1
Patient	1	2	3	References
Diabetes mellitus	Yes	No	Yes
Hypertension	Yes	No	No
Basal ACTH	78.9	79	1.6	7.2–63.3 pg/ml
Basal cortisol	15	21	3.2	5-20 mg/dl
LDDST	16	7.9	-	<1.8 mg/dl
24-h urinary free cortisol	153	144.5	-	<45 mg/24 h
Hemoglobin A1c	11.7	5.8		%5.7-6.4
Hemoglobin	10.5	13.0	11.4	12.0–15.5 g/dl
WBC	10.12	12.79	13.15	3.5–10.5×109/μL
Lymphocyte count	1.05	2.79	0.27	0.9–2.9×109/μL
Creatinin	0.6	0.78	0.85	0.57–1.11 mg/dl
C-reactive protein	304	14.7	360	<5 mg/l
Ferritin	88.8	19.30	1188	4.63–204 ng/ml
D-dimer	1.04	0.2	2.39	0-0.5 µg/mL
COVID-19 Vaccine	No	No	No

Conclusions: Cushing disease-associated glucocorticoid excess, immunosuppression and co-morbidities may alter the severity and the course of COVID-19. In contrast, glucocorticoids have shown improve COVID-19 associated mortality in randomized controlled trials. It was also reported that COVID-19 disease infection can be worsened by concomitant hypocortisolism. Herein we report three cases with different prognosis. Thus, patients with CD should be followed more carefully during COVID-19 disease.

Endocrine Abstracts

EP813