Challenges in the Management of the Patients with COVID-19 Infected Cushing’s Syndrome: Two Cases And Literature Review

Abstract

Coronavirus disease-2019 (COVID-19) has become a serious health problem in Turkey and the world. The diagnosis stage of many chronic diseases, the treatment process and the status of being affected by COVID-19 have become the focus of attention in the medical community during the pandemic, which has been continuing for nine months. We will discuss the course of COVID-19 infection over a 32-year-old and 76-year-old female patient with Cushing syndrome who applied to our clinic as a tertiary referral centre.

Keywords

• Cushing’s syndrome
• ectopic Cushing’s disease
• COVID-19
• hypercortisolism
• management

References

1. COVID Live Update: 195,172,426 Cases and 4,180,122 Deaths from the Coronavirus - Worldometer. Avaliable at: https://www.worldometers.info/coronavirus/?zarsrc=130. Accessed July 26, 2021.
2. Somasundaram NP, Ranathunga I, Ratnasamy V, Wijewickrama PSA, Dissanayake HA, Yogendranathan N, Gamage KKK, de Silva NL, Sumanatilleke M, Katulanda P, Grossman AB. The impact of SARS-Cov-2 virus infection on the Endocrine system. J Endocr Soc. 2020 Jul 2;4(8):bvaa082. doi: 10.1210/jendso/bvaa082.
3. Aranda G, Lopez C, Fernandez-Ruiz R, Esteban Y, Garcia-Eguren G, Mora M, Halperin I, Casals G, Enseñat J, Hanzu FA. Circulatory immune cells in Cushing syndrome: Bystanders or active contributors to atherometabolic injury? A study of adhesion and activation of cell surface markers. Int J Endocrinol. 2017;2017:2912763. doi: 10.1155/2017/2912763.
4. Hasenmajer V, Sbardella E, Sciarra F, Minnetti M, Isidori AM, Venneri MA. The immune system in Cushing’s syndrome. Trends Endocrinol Metab. 2020 Sep;31(9):655-69. doi: 10.1016/j.tem.2020.04.004.
5. Kakodkar P, Kaka N, Baig MN. A comprehensive literature review on the clinical presentation, and management of the pandemic coronavirus disease 2019 (COVID-19). Cureus. 2020 Apr 6;12(4):e7560. doi: 10.7759/cureus.7560.
6. Pivonello R, Ferrigno R, Isidori AM, Biller BMK, Grossman AB, Colao A. COVID-19 and Cushing’s syndrome: recommendations for a special population with endogenous glucocorticoid excess. Lancet Diabetes Endocrinol. 2020 Aug;8(8):654-6. doi: 10.1016/S2213-8587(20)30215-1.
7. T.C. Saglık Bakanlıgı. COVID-19 Bilgilendirme Platformu. COVID-19 rehberi. Avaliable at: https://covid19.saglik.gov.tr/TR-66301/covid-19-rehberi.html. Accessed August 29, 2021.
8. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the `Cytokine Storm’ in COVID-19. J Infect. 2020 Jun;80(6):607-13. doi: 10.1016/j.jinf.2020.03.037.

9. Monti S, Balduzzi S, Delvino P, Bellis E, Quadrelli VS, Montecucco C. Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis. 2020 May;79(5):667-8. doi: 10.1136/annrheumdis-2020-217424.
10. Fleseriu M, Buchfelder M, Cetas JS, Fazeli PK, Mallea-Gil SM, Gurnell M, McCormack A, Pineyro MM, Syro LV, Tritos NA, Marcus HJ. Pituitary society guidance: pituitary disease management and patient care recommendations during the COVID-19 pandemic-an international perspective. Pituitary. 2020 Aug;23(4):327-37. doi: 10.1007/s11102-020-01059-7.
11. Newell-Price J, Nieman LK, Reincke M, Tabarin A. ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of Cushing’s syndrome. Eur J Endocrinol. 2020 Jul;183(1):G1-7. doi: 10.1530/EJE-20-0352.
12. Barbot M, Ceccato F, Scaroni C. Consideration on TMPRSS2 and the risk of COVID-19 infection in Cushing’s syndrome. Endocrine. 2020 Aug;69(2):235-6. doi: 10.1007/s12020-020-02390-6.
13. Stopsack KH, Mucci LA, Antonarakis ES, Nelson PS, Kantoff PW. TMPRSS2 and COVID-19: Serendipity or opportunity for intervention? Cancer Discov. 2020 Jun;10(6):779-82. doi: 10.1158/2159-8290.CD-20-0451.
14. Serban AL, Ferrante E, Carosi G, Indirli R, Arosio M, Mantovani G. COVID-19 in Cushing disease: experience of a single tertiary centre in Lombardy. J Endocrinol Invest. 2021 Jun;44(6):1335-6. doi: 10.1007/s40618-020-01419-x.
15. Beretta F, Dassie F, Parolin M, Boscari F, Barbot M, Busetto L, Mioni R, De Carlo E, Scaroni C, Fallo F, Vettor R, Maffei P. Practical considerations for the management of Cushing’s disease and COVID-19: A case report. Front Endocrinol (Lausanne). 2020 Sep 11;11:554. doi: 10.3389/fendo.2020.00554.
16. Pivonello R, Isidori AM, De Martino MC, Newell-Price J, Biller BMK, Colao A. Complications of Cushing’s syndrome: State of the art. Lancet Diabetes Endocrinol. 2016 Jul;4(7):611-29. doi: 10.1016/S2213-8587(16)00086-3.
17. Nieman LK, Biller BM, Findling JW, Murad MH, Newell-Price J, Savage MO, Tabarin A; Endocrine Society. Treatment of Cushing’s syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015 Aug;100(8):2807-31. doi: 10.1210/jc.2015-1818.
18. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, Si HR, Zhu Y, Li B, Huang CL, Chen HD, Chen J, Luo Y, Guo H, Jiang RD, Liu MQ, Chen Y, Shen XR, Wang X, Zheng XS, Zhao K, Chen QJ, Deng F, Liu LL, Yan B, Zhan FX, Wang YY, Xiao GF, Shi ZL. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020 Mar;579(7798):270-3. doi: 10.1038/s41586-020-2012-7.
19. Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, Clark C, Iba T. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020 May;18(5):1023-6. doi: 10.1111/jth.14810.