Steroid and Thyroid Hormone Profiles in Patients Hospitalized With SARS-CoV-2

Context: SARS-CoV-2 is associated with adrenal and thyroid dysfunction. Steroid and thyroid hormone profiles were evaluated in patients hospitalized with SARS-CoV-2.Methods: Liquid chromatography mass spectrometry analysis of adrenocortical steroids [progesterone, corticosterone, 17-hydroxyprogesterone, 11-deoxycortisol, cortisol, cortisone, dehydroepiandrosterone (DHEA), androstenedione, testosterone], total thyroxine (TT4), total triiodothyronine (TT3), reverse triiodothyronine (rT3), and immunoassay analysis of adrenocorticotropic hormone (ACTH), thyroid stimulating hormone (TSH), luteinizing and follicle stimulating hormones, and aldosterone were performed from hospitalized SARS-CoV-2 patients. Data were dichotomized based on extracorporeal membrane oxygenation (ECMO) and survival status.Findings: Plasma analysis of a total of 63 plasma samples from ten patients (four females; median age: 41·5 years) revealed a median 11-deoxycortisol elevation up to 38-fold in male ECMO patients compared to non-ECMO patients, and up to 20-fold among female ECMO patients who died from SARS-CoV-2 compared to non-ECMO surviving patients. 11-deoxycortisol elevations were more profound and out of proportion to corresponding cortisol levels. Significantly higher levels were noted in plasma DHEA in male non-survivors, androstenedione in females with severe SARS-CoV-2, progesterone in males and female with severe SARS-CoV-2 infection, corticosterone, and aldosterone in male/female non-survivors. Median TT4, TT3, and rT3 levels were significantly lower in patients on ECMO and among non-survivors.Interpretation: The adrenal and thyroid axes can be affected during acute SARS-CoV-2 and the degree of disruption may be associated with disease severity, sex and ECMO status.Funding Information: This study was funded by the Intramural Programs of the National Institute of Diabetes and Digestive and Kidney Diseases, and National Institute of Allergy and Infectious Diseases, National Institutes of Health and by the COVID-19 Philanthropy provided to the Saint John’s Cancer Institute at Providence Saint John’s Health Center.Declaration of Interests: All authors have no conflicts of interest to disclose.Ethics Approval Statement: The study was approved by the Institutional Review Boards at PSJHC and NIH respectively.