Longitudinal study of antibody response following SARS-CoV-2 vaccination with Pfizer-BioNTech BNT162b2.

Objectives: To assess the immunity of healthcare and non-healthcare workers in the Alcoy health area (Spain) after completing three doses of the Pfizer-BioNTech vaccine and how it relates with individual factors. Methods: We conducted a prospective, observational, longitudinal, analytical study to observe immunogenicity in healthcare and non-healthcare workers at Virgen de los Lirios Hospital following administration of three doses of the Pfizer-BioNTech vaccine. Anti-SARS-CoV-2 spike protein IgG antibody concentrations were determined, while COVID-19 infections were identified by qualitative detection of IgG against the nucleocapsid protein. Samples from volunteers were analyzed 15 days, 3 months, and 6 months after receiving the second vaccine dose, and 12 months after receiving the third (booster) dose. A questionnaire was used to collect demographic data, risk factors, and use of immunosuppressive drugs. Statistical analyses were performed with SPSS software, and mean antibody levels over time were compared using ANOVA. Results: Participation was 99.5 % (199/200). The IgG concentration was higher in men and in obese individuals. No significant changes were noted in factors such as smoking. Conclusions: All participants developed humoral immunity, except for three subjects who were receiving immunosuppressive treatment. Participants with previous COVID-19 infection had higher antibody levels.

Two cases of Cushing's syndrome due to primary bilateral macronodular adrenal hyperplasia secondary to aberrant adrenal expression of hormone receptors.

OBJECTIVES: Primary bilateral macronodular adrenal hyperplasia is an uncommon cause of endogenous Cushing's syndrome characterized by the presence of aberrant adrenal expression of ectopic receptors that regulate steroidogenesis by mimicking the events triggered by ACTH receptor activation. Receptors of this type have been described for several hormones. The aim of the study is to detect these receptors in two patients with ACTH-independent hypercortisolism by means of the application of a screening protocol. DESIGN AND METHODS: A protocolized study of aberrant receptors was performed including measurements of ACTH, cortisol and other steroids and hormones. Upright posture test, mixed food and administration of Gonadotropin-Releasing Hormone (GnRH) were used as stimuli. In both patients, a stimulation test with intravenous ACTH was conducted to determinate the cortical response capacity. The study was carried out in three separate days. RESULTS: The first patient, who had a hypergonadotropic hypogonadism, presented anomalous cortisol response to the GnRH stimulation, with potential medical treatment by the use of exogenous testosterone. In the second case, the patient with clinical Cushing's syndrome presented anomalous cortisol response to standing, whose potential medical treatment would be the use of beta-blockers. CONCLUSIONS: This etiological variant of ACTH-independent Cushing's syndrome leads to the use of specific pharmacologic therapies in some cases as alternatives to adrenalectomy. The studied cases show the importance of having a high degree of suspicion when diagnosing less frequent types of Cushing's syndrome.