Growth hormone level in COVID-19 patients.

OBJECTIVE: Coronavirus disease-2019 (COVID-19) disease can cause asymptomatic and mild flu-like symptoms as well as severe symptoms ranging from respiratory failure and death. Growth hormone (GH) is produced in the anterior pituitary and plays an important role in the immune system. COVID-19 is severe in the elderly, men, obese, diabetics, and people with immune deficiency. The probability of GH deficiency is high in these patient groups. In this study, we aimed to investigate the relationship between the severity of COVID-19 infection and GH level. METHODS: A total of 456 patients, between 45 and 80-years-old, who were hospitalized with the diagnosis of COVID-19 disease were evaluated in the study. Our study was a retrospective study. Demographic data of the patients, GH, insulin-like growth factor-I (IGF-1), and biochemical parameters and thorax tomography results were evaluated. Patients with chronic diseases that would affect GH levels and those in need of intensive care were excluded from the study. RESULTS: 456 patients were included in the study, 168 female, 288 male, mean age 67.57±12.60 years. Patients were divided into two groups according to thorax tomography findings, patients with lung involvement in Group-1:352 (77%) and those without pulmonary involvement in Group-2:104 (23%). While the GH of Group-1 was 0.125 ng/ml, the GH of Group-2 was 0.238 ng/ml, the difference between them was statistically significant (p=0.000). IGF-1 in Group-1 was: 55.05 ng/ml, while IGF-1 in Group-2 was: 104.08 ng/ml, the difference between them was statistically significant (p=0.000). In multivariate regression analysis, low IGF-1 (p=<0,01, OR:1,06 [1028-1093]) level was found to be significantly effective in lung involvement in COVID-19 disease. CONCLUSION: In our study, we found GH and IGF-1 deficiency in COVID-19 cases with lung involvement, regardless of age and gender. We can say that COVID-19 infection progresses worse in GH and IGF-1 deficiency.

Plasmapheresis for the Treatment of Crescentic Postinfectious Glomerulonephritis: A Case Report.

Postinfectious glomerulonephritis (PIGN) is an immune-mediated glomerulonephritis caused by bacterial infections. Treatment of PIGN includes appropriate treatment of underlying infection and supportive treatment of the nephritic syndrome. Immunosuppressive drugs may be used to treat PIGN who have a renal failure with or without crescents and suggested only to the patients who does not have an active infection. We report a case who had PIGN secondary to a chronic foot infection and successfully treated with plasmapheresis for the first time in the literature.

Adrenal Insufficiency Secondary to Peritoneal Dialysis-Related Peritonitis: A Case Report.

Peritoneal dialysis (PD)-related peritonitis is one of the most important factors affecting the long-term success of PD. Adrenal insufficiency is a clinical manifestation of inadequate production of glucocorticoids with accompanying deficiency of mineralocorticoids and adrenal androgens. We present a 58-year-old PD patient who admitted to hospital with fever, abdominal pain, vomiting, and confusion. The patient was treated with cephazolin and ceftazidime after the confirmation of peritonitis. Despite the resolution of peritonitis after 2 weeks with appropriate antibiotic treatment, the patient continued to suffer from vomiting, hypotension, and confusion. After the evaluation of basal serum cortisol and 250 µg ACTH stimulation test, the patient had been diagnosed as adrenal insufficiency and treated with fludrocortisone 0.1 mg/day. Patients remaining vomiting, hypotension, and confusion symptoms were corrected after the fludrocortisone therapy. Following 2 months of successful treatment of adrenal insufficiency, the patient had adherence problem with fludrocortisone for 3-4 weeks. On an outpatient visit, serum ACTH and cortisol levels were normal despite the discontinuation of fludrocortisone and so the patient had been evaluated as partial adrenal insufficiency secondary to PD-related peritonitis. In conclusion, adrenal insufficiency should be kept in mind in PD patients suffering from hypotension and peritonitis.