Einstein International Journal Organization(EIJO)

Background: Many survivors of the severe acute respiratory syndrome (SARS) outbreak were found to have psychosomatic symptoms that were similar to endocrine abnormalities. As a result, we wanted to see if there were any persistent endocrine sequelae in SARS survivors.

Patients, design, and measurements: Three months after recovery, sixty-one SARS survivors were prospectively recruited and tested for hormonal imbalances. Patients with endocrine problems were not allowed to participate. Up to a year, any endocrine problems discovered were evaluated and treated as needed. Serial examination aided in the identification of trends and the prognosis of any endocrinological abnormalities.

Results Twenty-four patients (393%) showed signs of hypocortisolism. The majority of patients' hypothalamic–pituitary–adrenal (HPA) axis abnormalities resolved within a year. Transient subclinical thyrotoxicosis was found in two (33% of the hypocortisolic group). Four (67%) of the participants were biochemically hypothyroid, with three having central hypothyroidism and one having primary hypothyroidism. Two of the three had central hypothyroidism and central hypocortisolism at the same time. Eight of the participants had DHEAS levels that were below normal.

Conclusions: These preliminary data suggest that SARS-associated coronavirus may have a role in generating reversible hypophysitis or a direct hypothalamic effect, with the HPA axis being affected more frequently than the HPT axis.

Keywords: Hypothalamic–Pituitary–Adrenal, Hypophysitis, Central Hypothyroidism

1. Frohman, L.A. &Felig, P. (2001) The clinical manifestations of endocrine disease. In: P. Felig, L.A. Frohman eds. Endocrinology and Metabolism, 4th edn. McGraw-Hill, New York, 19 – 28.
2. Kathol, R.G., Noyes, R. & Lopez, A. (1988) Similarities in hypothalamic– pituitary–adrenal axis activity between patients with panic disorder and those experiencing external stress. Psychiatric Clinics of North America, 11, 335 –348.
3. Kjellman, B.F., Thorell, L.H., Orhagen, T., d’Elia, G. &Kagedal, B. (1993) The hypothalamic–pituitary–thyroid axis in depressive patients and healthy subjects in relation to the hypothalamic–pituitary– adrenal axis. Psychiatry Research, 47, 7 –21.
4. World Medical Association General Assembly. (2004) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Journal of International Bioethique, 15, 124– 129.
5. Berger, A., Drosten, C.H., Doerr, H.W., Sturmer, M. &Preiser, W. (2004) Severe acute respiratory syndrome (SARS) – paradigm of an emerging viral infection. Journal of Clinical Virology, 29, 13–22.