Unpacking the Science Behind Long COVID: How Adrenal Gland SARS-CoV-2 Infection May Play A Key Role!

Long COVID-19 News: As the COVID-19 pandemic continues to ravage the world, researchers and medical professionals are starting to take note of a troubling phenomenon: Long COVID. This condition, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), affects some individuals who have recovered from the initial acute phase of COVID-19. There are many possible factors that can contribute to Long COVID manifestations …one of which is SARS-CoV-2 infection and damage of the adrenal glands!


 
Introduction to Long COVID
When COVID-19 first emerged in late 2019, it was thought to be a respiratory illness that primarily affected the lungs. However, as the pandemic progressed, it became clear that COVID-19 was a systemic disease that could affect multiple organ systems. While the acute phase of COVID-19 can be severe and even deadly, most people recover within a few weeks. However, for some individuals, symptoms persist for months after the initial infection has cleared. This condition is known as Long COVID.
 
What is Long COVID?
Long COVID is a condition in which individuals experience persistent symptoms after recovering from the acute phase of COVID-19. According to a study published in The Lancet, up to 76% of individuals who have had COVID-19 experience at least one symptom of Long COVID, and up to 63% experience fatigue or muscle weakness. Other common symptoms include shortness of breath, chest pain, difficulty concentrating, and depression.
 
The mystery behind Long COVID
One of the most troubling aspects of Long COVID is that the cause of the condition is still not fully understood. While some researchers believe that Long COVID is caused by persistent viral infection, others think that it may be due to an autoimmune response or a dysregulated immune system. Still, others believe that Long COVID may be the result of damage to specific organs, such as the lungs or the heart.
 
SARS-CoV-2 also infects and damages the adrenal glands
Recent research has suggested that not only does the SARS-CoV-2 virus infect and damage the adrenal gland.
https://www.thailandmedical.news/news/breaking-german-and-swiss-study-discovers-sars-cov-2-targets-and-causes-cellular-damage-to-adrenal-glands-resulting-in-a-variety-of-health-conditions
 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601687/
 
https://pubmed.ncbi.nlm.nih.gov/35944524/
 
https://www.nature.com/articles/s41467-022-29145-3
 
https://www.frontiersin.org/art icles/10.3389/fendo.2020.593179/full
 
In one study, the research team compared the adrenal gland tissues from the 40 deceased patients with the adrenal gland tissues of patients who died before the COVID-19 pandemic. In 18 of the 40 cases, the team using a monoclonal antibody, confirmed the presence of SARS-CoV-2 spike protein in the adrenocortical cells.
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00291-6/fulltext
 
Case studies and research have also showed a dysfunctional adrenal gland as a result of COVID-19 infection.
https://casereports.bmj.com/content/14/1/e237690
 
https://pesquisa.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/resource/pt/covidwho-1984482
 
https://www.cureus.com/articles/84297-secondary-adrenal-insufficiency-after-covid-19-diagnosed-by-insulin-tolerance-test-and-corticotropin-releasing-hormone-test#!/
 
Studies have proposed that the resulting damage or dysfunction to the adrenal glands also leads to manifestations seen in Long COVID!
https://www.nature.com/articles/s41574-022-00700-8
 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537520/
 
What are adrenal glands?
The adrenal glands are small, triangular-shaped glands located on top of the kidneys. They are responsible for producing hormones that regulate a wide range of bodily functions, including blood pressure, metabolism, and the body's response to stress. The adrenal glands are divided into two parts: the adrenal cortex and the adrenal medulla. The adrenal cortex produces hormones such as cortisol, aldosterone, and androgens, while the adrenal medulla produces adrenaline and noradrenaline.
 
How do adrenal glands work?
The adrenal glands work in conjunction with the hypothalamus and the pituitary gland to regulate the body's response to stress. When the hypothalamus detects a stressor, it releases a hormone called corticotropin-releasing hormone (CRH). CRH then stimulates the pituitary gland to release adrenocorticotropic hormone (ACTH), which in turn stimulates the adrenal glands to produce cortisol.
 
Adrenal gland infection and its effects on the body that leads to Long COVID
When the adrenal glands become infected, they may produce too much or too little of certain hormones, leading to a range of symptoms. Infections of the adrenal glands can be caused by a variety of pathogens, including viruses, bacteria, and fungi. Symptoms of adrenal gland infection can include fatigue, weakness, weight loss, nausea, and vomiting.
https://www.thailandmedical.news/news/coronavirus-news-tiredness-and-fatigue-in-the-covid-19-era-could-be-due-to-addison-s-disease-as-sars-cov-2-also-attacks-the-adrenal-glands
 
https://www.thailandmedical.news/news/first-documented-long-covid-case-study-involving-impaired-secretion-of-adrenocorticotropic-hormone-due-to-sars-cov-2-infection
 
One study showed that as a result of COVID-19 affecting the adrenal glands, chronic fatigue is often observed in Long COVID.
https://www.sciencedirect.com/science/article/pii/S2214623721000363
 
There are at about 12 published case studies and nine prospective case series describing adrenal insufficiency related to COVID-19. These studies reported that adrenal haemorrhages and infarctions might not only occur in severe cases of COVID-19, but also in mild ones.
https://academic.oup.com/jcem/article/107/1/e394/6330483
 
COVID-19 might predispose patients to reversible dysfunction of the adrenal glands, known as critical illness-related corticosteroid insufficiency (CIRCI). In CIRCI, glucocorticoid actions are insufficient to control cellular inflammation. Multiple factors could contribute to the development of CIRCI in patients with COVID-19, including dysregulation of the hypothalamic–pituitary–adrenal axis, reduced cortisol metabolism or glucocorticoid receptor alpha tissue resistance. Based on morning cortisol levels (<10 µg/dl) or a cortisol increase in response to adrenocorticotropic hormone (ACTH) stimulation (<9 µg/dl), the frequency of CIRCI among patients with mild or severe COVID-19 was found to be 4.4–32.0%8.
https://www.nature.com/articles/s41574-022-00700-8
 
Although the majority of studies reported adequate adrenal cortisol levels in patients with acute COVID-19, adrenal gland insufficiency cannot be excluded, particularly because the manifestation of adrenal insufficiency might be either delayed or masked by decreased cortisol metabolism.
 
Consequently, adrenal insufficiency might develop several weeks after an acute phase of COVID-19. Late-onset of adrenal gland insufficiency in patients who recovered from SARS-CoV-2 infection could be a direct consequence of persisting dysregulation of the hypothalamic–pituitary–adrenal axis, reactivation of latent viral infections, such as cytomegalovirus, or an autoimmune response against key factors involved in the regulation of adrenocortical cell function. In line with this hypothesis, it has been suggested that there is a high molecular similarity between SARS-CoV-2 peptides and human adrenocorticotropic hormone. Although there is currently not enough clinical evidence supporting this claim, high titers of anti-ACTH antibodies were found in patients with Long COVID, indicating a potential pathophysiological mechanism for an adrenocorticotropic impairment related to infections with COVID-19.
https://pubmed.ncbi.nlm.nih.gov/34642524/
 
Possible treatments for Long COVID related to adrenal gland infection
If adrenal gland infection is found to be a key factor in Long COVID, there may be several potential treatments that could help alleviate symptoms. For example, antiviral medications may be used to target the underlying infection, while hormone replacement therapy may be used to regulate hormone levels. Additionally, lifestyle changes such as stress reduction and exercise may also be helpful in managing the symptoms of Long COVID.
 
Conclusion and future research directions for Long COVID treatment
In conclusion, adrenal vascular damage triggered by COVID-19 might develop as a complication, predisposing the patient to adrenal insufficiency, with potential life-threatening consequences.
 
Long COVID is a complex and multifaceted condition that is not yet fully understood. While the role of adrenal gland infection in this condition is still being studied, recent research suggests that it may play a key role in the development of Long COVID. Further research is needed to better understand the underlying mechanisms of Long COVID and to develop effective treatments for this condition. In the meantime, it is important for individuals who are experiencing persistent symptoms after recovering from COVID-19 to seek medical attention and to work with their healthcare providers to manage their symptoms.
 
For the latest Long COVID News, keep on logging to Thailand Medical News.
 
Read Also:
https://www.thailandmedical.news/news/university-of-cambridge-researchers-discover-that-hospitalized-covid-19-patients-typically-exhibit-extreme-hypoaldosteronism