Observational studyFrontiers in endocrinology2020
The Adrenal Cortex, an Underestimated Site of SARS-CoV-2 Infection.
Observational study in Frontiers in endocrinology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
51 citing papers in PubMed, 99 citations in OpenAlex.
- Unmasking Adrenal Insufficiency in COVID-19: The Diagnostic Challenge of Concomitant Acute Kidney Injury and High Ileostomy Output.The American journal of case reports · 2026Article
- Article
- Impact of COVID-19 on pituitary function: a cross-sectional study in southern Iran.BMC endocrine disorders · 2025Article
- Hypothalamic-pituitary-adrenal dynamics in early-stage COVID-19 observed in a case with arginine vasopressin deficiency.BMC endocrine disorders · 2025Article
- Hormonal Implications of SARS-CoV-2: A Review of Endocrine Disruptions.Scientifica · 2025Review
- Effect of Pituitary-Target Gland Axis on RAAS in the Context of COVID-19.International journal of medical sciences · 2025Review
- Syndrome of inappropriate antidiuresis/hyponatremia in COVID-19.Pituitary · 2024Review
- Implications of Dysnatremia and Endocrine Disturbances in COVID-19 Patients.International journal of molecular sciences · 2024Review
- Endogenous serum glucocorticoid concentrations, steroidogenic enzyme activity, and 90-day mortality in patients hospitalized with COVID-19: an observational cohort study.Endocrine connections · 2024Article
- SARS-CoV-2 Affects Thyroid and Adrenal Glands: AnBiomedicines · 2023Article
- COVID-19 pandemic and adrenals: deep insights and implications in patients with glucocorticoid disorders.Endocrine · 2023Review
- Endocrine manifestations of COVID-19 in children: A scoping review.Best practice & research. Clinical endocrinology & metabolism · 2023Article
- SARS-CoV-2 infection and its effects on the endocrine system.Best practice & research. Clinical endocrinology & metabolism · 2023Review
- Changes in Cortisol Secretion and Corticosteroid Receptors in COVID-19 and Non COVID-19 Critically Ill Patients with Sepsis/Septic Shock and Scope for Treatment.Biomedicines · 2023Review
- Outcome of COVID-19 infections in patients with adrenal insufficiency and excess.Endocrine connections · 2023Article
- Approach to the Patient With Adrenal Hemorrhage.The Journal of clinical endocrinology and metabolism · 2023Article
- Letter to the editor of clinical endocrinology: Assessment of adrenal function in patients who survive COVID-19.Clinical endocrinology · 2023Article
- Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS: a descriptive analysis.Frontiers in endocrinology · 2023Article
- Critical Illness-Related Corticosteroid Insufficiency (CIRCI) Among Patients with COVID-19 at a Tertiary Hospital: Clinical Characteristics and Outcomes.Journal of the ASEAN Federation of Endocrine Societies · 2023Article
- Primary adrenal insufficiency and myocarditis in COVID-19 disease: a case report.BMC endocrine disorders · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: The majority of the critically ill patients may have critical illness-related corticosteroid insufficiency (CIRCI). The therapeutic effect of dexamethasone may be related to its ability to improve cortical function. Recent study showed that dexamethasone can reduce COVID-19 deaths by up to one third in critically ill patients. The aim of this article is to investigate whether SARS-CoV-2 can attack the adrenal cortex to aggravate the relative adrenal insufficiency. Methods: We summarized the clinical features of COVID-19 reported in currently available observational studies. ACE2 and TMPRSS2 expression was examined in human adrenal glands by immunohistochemical staining. We retrospectively analyzed serum cortisol levels in critically ill patients with or without COVID-19. Results: High percentage of critically ill patients with SARS-COV-2 infection in the study were treated with vasopressors. ACE2 receptor and TMPRSS2 serine protease were colocalized in adrenocortical cells in zona fasciculata and zona reticularis. We collected plasma cortisol concentrations in nine critically ill patients with COVID-19. The cortisol levels of critically ill patients with COVID-19 were lower than those in non-COVID-19 critically ill group. Six of the nine COVID-19 critically ill patients had random plasma cortisol concentrations below 10 µg/dl, which met the criteria for the diagnosis of CIRCI. Conclusion: We demonstrate that ACE2 and TMPRSS2 are colocalized in adrenocortical cells, and that the cortisol levels are lower in critically ill patients with COVID-19 as compared to those of non-COVID-19 critically ill patients. Based on our findings, we recommend measuring plasma cortisol level to guide hormonal therapy.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.