Can Serum Cortisol Be Used To Monitor Patients With COVID-19?

Abstract

Therapeutic administration of steroids (or corticosteroids) in patients with coronavirus disease (COVID-19) is controversial owing to risk of adrenal insufficiency or immunosuppression from prolonged use. A recent clinical trial report presenting preliminary data suggested survival benefits of low-dose dexamethasone in patients with severe COVID-19. Additionally, there is evidence that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-mediated pathogenetic mechanisms can involve the adrenal gland, and can therefore influence endogenous production of steroids, mainly cortisol. Cortisol is an output hormone of the hypothalamic–pituitary–adrenal axis—the chief endocrine axis maintaining physiological homeostasis. Despite the known dangers of possible endocrine disruption, there has been very little discussion in the literature regarding monitoring of serum cortisol concentrations in patients with COVID-19. In this article, we briefly discuss existing and emerging empirical evidence in favor of monitoring serum cortisol concentrations in patients with severe COVID-19 in terms of improving survival outcomes as well as facilitating better therapeutic management.