Plasma steroid concentrations reflect acute disease severity and normalise during recovery in people hospitalised with COVID-19

SUMMARY

OBJECTIVE
Endocrine systems are disrupted in acute illness, and symptoms reported following COVID-19 are similar to those found with clinical hormone deficiencies. We hypothesised that people with severe acute COVID-19 and with post-COVID symptoms have glucocorticoid and sex hormone deficiencies.

DESIGN/PATIENTS
Samples were obtained for analysis from two UK multi-centre cohorts during hospitalisation with COVID-19 (ISARIC/WHO CCP-UK study), and at follow-up 5 months after hospitalisation (PHOSP-COVID study).

MEASUREMENTS
Plasma steroids were quantified by liquid chromatography-mass spectrometry Steroid concentrations were compared against disease severity (WHO ordinal scale) and validated symptom scores. Data are presented as geometric mean (SD).

RESULTS
In the acute cohort (n=239, 66.5% male), plasma cortisol concentration increased with disease severity [cortisol 753.3 (1.6) vs. 429.2 (1.7) nmol/L in fatal vs. least severe, p<0.001]. In males, testosterone concentrations decreased with severity [testosterone 1.2 (2.2) vs. 6.9 (1.9) nmol/L in fatal vs. least severe, p<0.001].

In the follow-up cohort (n=198, 62.1% male, 68.9% ongoing symptoms, 165 (121-192) days post-discharge), plasma cortisol concentrations [275.6 (1.5) nmol/L] did not differ with in-hospital severity, perception of recovery, or patient-reported symptoms. Male testosterone concentrations [12.6 (1.5) nmol/L] were not related to in-hospital severity, perception of recovery or symptom scores.

CONCLUSIONS
Circulating glucocorticoids in patients hospitalised with COVID-19 reflect acute illness, with a marked rise in cortisol and fall in male testosterone. These findings are not observed 5 months from discharge. The lack of association between hormone concentrations and common post-COVID symptoms suggests steroid insufficiency does not play a causal role in this condition.