Low growth hormone secretion associated with post-acute sequelae SARS-CoV-2 infection PASC neurologic symptoms: A case-control pilot study,2023,Wright

[SNT Gatchaman]

Low growth hormone secretion associated with post-acute sequelae SARS-CoV-2 infection PASC neurologic symptoms: A case-control pilot study
Wright; Pyles; Sheffield-Moore; Deer; Randolph; McGovern; Danesi; Gilkison; Ward; Vargas; Armstrong; Lindsay; Zaidan; Seashore; Wexler; Masel; Urban

Objective: To determine if patients that develop lingering neurologic symptoms of fatigue and “brain fog” after initial recovery from coronavirus disease 2019 (COVID-19) have persistent low growth hormone (GH) secretion as seen in other conditions with similar symptom etiology.

Design: In this case-control observational pilot study, patients reporting lingering neurologic post-acute sequelae of SARS-CoV-2 (PASC, n=10) symptoms at least 6 months after initial infection were compared to patients that recovered from COVID-19 without lingering symptoms (non-PASC, n=13). We compared basic blood chemistry and select metabolites, lipids, hormones, inflammatory markers, and vitamins between groups. PASC and non-PASC subjects were tested for neurocognition and GH secretion, and given questionnaires to assess symptom severity. PASC subjects were also tested for glucose tolerance and adrenal function.

Results: PASC subjects reported significantly worse fatigue, sleep quality, depression, quality of life, and gastrointestinal discomfort compared to non-PASC. Although PASC subjects self-reported poor mental resilience, cognitive testing did not reveal significant differences between groups. Neurologic PASC symptoms were not linked to inflammatory markers or adrenal insufficiency, but were associated with reduced growth hormone secretion.

Conclusions: Neurologic PASC symptoms are associated with gastrointestinal discomfort and persistent disruption of GH secretion following recovery from acute COVID-19.

Link | Paywall (Molecular and Cellular Endocrinology)

 

[SNT Gatchaman]

Small numbers/pilot study. They didn't measure early morning cortisol (as in Distinguishing Features... 2023) but instead did a stimulation test.

In our subjects, cortisol stimulation testing did not indicate disruption to the HPA axis.

For growth hormone they did a glucagon stimulation test —

In the current pilot study, symptomatic PASC patients had significantly lower GH secretion during stimulation testing (in both peak GH and AUC) than patients that recovered without lingering symptoms. It is worth noting that the individual outlier with unusually high GH levels in the non-PASC group was not the source of statistical significance. If values from that individual are removed from analysis, the groups remain significantly different for both peak GH (P=.030) and total AUC (P=.028). Although stimulated GH levels differed significantly between groups, IGF-1 levels did not.

 

[SNT Gatchaman]

Reduced cognitive function has been linked with COVID-19 and may persist months after initial infection. In this study, the Mental Fatigue subscale of the MFSISF provided a patient self-assessment of mental resilience. PASC subjects scored significantly lower on this scale than non-PASC, suggesting that PASC subjects perceived more cognitive difficulties related to memory, confusion, and attention. However, neurocognitive testing (MoCA) did not detect differences in cognitive function between groups. Minor deficits in cognitive function may not be detected by neuropsychological tests, and the cognitive impairment associated with PASC may be subtle and nuanced, involving cognitive control as seen in patients following mild TBI.

I'm sure this will have been discussed before, but is there an equivalent concept in cognitive testing of the 2-day CPET? Possibly for cognitive tasks 2, 6 or 8 hours might show a reduction in capability on objective tests, i.e. earlier than 24 hours, but I haven't looked to see if this has been assessed.