Long-Covid has become an important
topic, as many patients who contracted COVID-19 have experienced prolonged
symptoms, lasting weeks if not months after their original illness. The most
common symptoms reported are fatigue and shortness of breath, but others have
also presented with cognitive impairments, palpitations, inability to taste,
gastrointestinal issues, cough, headaches, and even mood fluctuations (1).
Various treatments have been tried, both by allopathic and functional medicine
practitioners, with varied success.
Teasing out the pathophysiology of this
post-viral syndrome is essential in formulating more focused and effective
treatments.
Currently, there are a few theories on how COVID infections can result in long-haul symptoms. Risk factors for the condition seem to include female gender, multiple early symptoms, early shortness of breath, prior mood disorders, and some lab markers of inflammation. From this, many hypothesize that these symptoms arise from long-term tissue damage from the virus, and dysregulated inflammation exacerbated by the virus (1). From a functional perspective, cortisol levels and adrenal function are closely related to many of these concerns, making it an avenue that may be beneficial to look more closely at.
One indicator that the adrenal gland, and therefore cortisol, may be affected by long-covid, is the correlation of symptoms between this condition and adrenal insufficiency symptoms including extreme fatigue, weakness, nausea, dizziness, and joint pain. Salzano et al, in 2021 noticed this correlation and decided to look further. In their report, they described a 38 year old female with long-covid related symptoms, who had a full work up of normal results post illness, other than when examining cortisol levels. They found that the cortisol pathway was affected and started the patient on hydrocortisone acetate. At re-evaluation, many of her symptoms had improved, though had not yet resolved (2).
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These researchers discussed their hypotheses regarding cause, as research has not yet been able to elucidate this, but they did present multiple possibilities. For one, many COVID patients did have high dose dexamethasone as a treatment, which could have caused suppression of the hypothalamus-pituitary-adrenal system. Another possibility is that the virus itself damages the adrenal gland. This has been reported in studies looking at autopsy studies in patients who had contracted COVID-19. They found that the virus could be identified within the adrenal gland and that there was damage associated with it, including necrosis of the tissue (2).
Another study completed in 2022 reported similar findings. They found similarities between long COVID and other post-viral chronic stress type conditions that were linked to low cortisol. They suggested this was due to suppression of the hypothalamic-pituitary-adrenal axis during acute illness, with predisposed individuals unable to recover this function (3).
Looking at these preliminary studies, it is a reasonable avenue to evaluate in patients with long-covid symptoms. Thankfully, cortisol is rather easy to test - either through blood, urine, or saliva. Salivary cortisol provides a quick, easy, and thorough method of evaluating the entire 24 hour production of the hormone because patients can provide samples at various times of day, obtaining information on the overall cycling of this hormone rather than a snapshot, as it fluctuates throughout the day.
With this knowledge, patients can be supported on diet, lifestyle, supplemental, and even pharmaceutical interventions that may relive these debilitating symptoms.
For more information regarding testing, please visit www.ayumetrix.com or email info@ayumetrix.com.
- Mary Hall, ND, LAc
References:
1. Yong, Shin Jie. 2021. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infect Dis (Lond.): 53(10): 737-754.
2. Salzano, C., Saracino, G., Cardillo, G. 2021. Possible adrenal involvement in long COVID syndrome. Medicina (Kaunas): 57(10): 1087.
3. Yavropoulou, M.P., Tsokos, G.C., Chrousos, G.P., Sfikakis, P.P. 2022. Protracted stress-induced hypocortisolemia may account for the clinical and immune manifestations of Long-COVID. Clin Immunol: 245: 109133.
