COVID-19, hypocortisolism, and psychosomatic sequelae

There is preliminary evidence that some patients recovering from novel coronavirus disease (COVID-19) may experience ongoing symptoms such as myalgia, fatigue and headache. Such symptoms have been observed as persistent sequelae of the earlier outbreak of severe acute respiratory syndrome (SARS). In this paper, evidence is presented that novel coronavirus infections may be associated with hypocortisolism which may persist for weeks or months, and that this may be a risk factor for both post-viral symptoms and post-traumatic stress disorder in patients recovering from COVID-19. The mechanisms underlying this phenomenon may involve reversible inflammation or dysfunction at the level of the pituitary gland, or a dysregulated host immune or stress response. The implications of these findings for the assessment and management of patients recovering from the acute phase of COVID-19 are discussed.