Journal
REVIEWS IN ENDOCRINE & METABOLIC DISORDERS
Volume 22, Issue 4, Pages 703-714Publisher
SPRINGER
DOI: 10.1007/s11154-020-09598-x
Keywords
Cushing's syndrome; SarsCoV2; Glucocorticoid; Infections; Cortisol; Immune system
Categories
Funding
- Universita degli Studi di Palermo within the CRUI-CARE Agreement
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Patients with hypercortisolism are at higher risk of developing severe COVID-19 infection due to increased susceptibility caused by glucocorticoid excess. The European Society of Endocrinology has recently issued urgent clinical guidance for managing Cushing's syndrome during the COVID-19 pandemic.
The pandemic of coronavirus disease (COVID-19), a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is causing high and rapid morbidity and mortality. Immune system response plays a crucial role in controlling and resolving the viral infection. Exogenous or endogenous glucocorticoid excess is characterized by increased susceptibility to infections, due to impairment of the innate and adaptive immune system. In addition, diabetes, hypertension, obesity and thromboembolism are conditions overrepresented in patients with hypercortisolism. Thus patients with chronic glucocorticoid (GC) excess may be at high risk of developing COVID-19 infection with a severe clinical course. Care and control of all comorbidities should be one of the primary goals in patients with hypercortisolism requiring immediate and aggressive treatment. The European Society of Endocrinology (ESE), has recently commissioned an urgent clinical guidance document on management of Cushing's syndrome in a COVID-19 period. In this review, we aim to discuss and expand some clinical points related to GC excess that may have an impact on COVID-19 infection, in terms of both contagion risk and clinical outcome. This document is addressed to all specialists who approach patients with endogenous or exogenous GC excess and COVID-19 infection.
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