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927 – Hormonal Dysregulation in Long COVID: Exploring the Salivary Cortisol Profile, 2025, Camici et al

Discussion in 'Long Covid research' started by forestglip, Mar 12, 2025.

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  1. forestglip

    forestglip Senior Member (Voting Rights)

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    927 – Hormonal Dysregulation in Long COVID: Exploring the Salivary Cortisol Profile

    Marta Camici, Marta Franco, Lorenzo Talamanca, Manuela Petino, Jessica Paulicelli, Liliana Scarnecchia, Alessandra Vergori, Stefano Curcio, Roberto Baldelli, Paolo Zuppi, Andrea Antinori

    [Line breaks added]

    Background
    While reduced morning serum cortisol (SC) is common in long COVID (LC) patients, measuring salivary cortisol throughout the day better reflects dynamic secretion and may offer greater sensitivity than SC. This study investigates this relationship, alongside hormonal dysregulation and LC predictors.

    Methods
    This prospective, single-center, case-control study at a LC-clinic in Rome included 96 participants assessed at least 28 days post-positive SARS-CoV-2 PCR test. LC was defined as at least one new or persisting symptom, with severe LC defined as four or more of fatigue, concentration/memory deficits, poor exercise tolerance, dyspnea, arthralgia, or dysautonomia. Fatigue, assessed using the Fatigue Assessment Scale (FAS) at baseline and 12 weeks, was defined as FAS ≥ 22 (severe: FAS ≥ 35).

    Two weeks post-BL, blood samples for hormonal assessment and salivary cortisol samples (8:00 AM, 3:00 PM, 11:00 PM) were collected. Patients with SC <15 µg/dL underwent a 1 µg ACTH stimulation test to assess for adrenal insufficiency. Salivary cortisol data from a control group (healthy, COVID-19-free for 4+ months) were also analyzed.

    Results
    Of 96 patients, 60% were female, all white, mean age 58 ± 15 yrs, 61% had >3 comorbidities, 42% had prior COVID-19, and the mean SARS-CoV-2 vaccine doses received was 2.9 ± 1. 62.5% exhibited FAS scores ≥ 22.

    LC was present in 86% of participants, with 80% experiencing moderate and 20% severe symptoms. 13.5% were asymptomatic post-COVID (APC).

    Altered FAS was strongly associated with both LC presence and severity (p<0.0001), and negatively impacted daily life (p<0.001).

    Vaccination was found to be protective (p=0.03), while psychiatric comorbidities increased LC risk (p=0.04). One LC patient (1.2%) had adrenal insufficiency requiring replacement therapy.

    Morning salivary cortisol was higher in controls than in both APC and LC groups (p=0.005), while afternoon/evening cortisol was lower (Figure 1).

    Although morning SC did not differ between groups, median ACTH was higher in LC than APC (26 pg/ml vs 13 pg/ml; p<0.001).

    No differences were observed between groups for testosterone, DHEAS, TSH, ft3, or ft4. Median TSH was higher in the pathological FAS group (2.07 mU/L vs 1.58 mU/L; p=0.004).

    Conclusions
    This study reveals a disrupted circadian cortisol rhythm in individuals post-COVID-19, marked by lower daytime and higher evening/nighttime cortisol levels, potentially correlating with disease severity. Elevated ACTH levels in LC may suggest adrenal impairment.

    Link (Conference on Retroviruses and Opportunistic Infections) [Abstract Only]
     
    forestglip, Mar 12, 2025
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  2. forestglip

    forestglip Senior Member (Voting Rights)

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    I don't know what the difference is between the control group and the asymptomatic post-COVID group.
     
    forestglip, Mar 12, 2025
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    Deanne NZ and Hutan like this.
  3. Hutan

    Hutan Moderator Staff Member

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    Yeah, that's a really confusing abstract.

    It isn't clear how the APC cohort was recruited. Were they attendees at the Long Covid clinic who were assessed as not having Long Covid? The 96 participants are described as 'patients', with 83 forming the Long Covid group and only 13 forming the 'asymptomatic post-Covid' group. But, if all were patients, then either the APC people had recovered by the time of assessment or somehow their symptoms were not counted as meeting LC criteria (perhaps they had symptoms before the Covid-19 infection).

    And then it seems that there was another group of an unspecified size, healthy Covid 19-free controls used for evaluating salivary cortisol levels.


    That's another confusing set of statements. If the APC and LC groups are drawn from people attending the Long Covid clinic, then it is likely that their lifestyle is different to that of the healthy controls. That is, they probably are not engaging in vigorous activity, have a later waking time and are not routinely rushing around in the morning. That lifestyle pattern would tend to lower morning salivary levels and account for the observed pattern of higher afternoon and evening cortisol in the APC and LC groups compared to the controls.
     
    Hutan, Mar 12, 2025
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  4. alktipping

    alktipping Senior Member (Voting Rights)

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    Hasn't this been a dead end for the last 30 or so years .
     
    alktipping, Mar 12, 2025
    #4
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