Possible Adrenal Involvement in Long COVID Syndrome

Background: A significant number of patients with COVID-19 experience prolonged symptoms, known as Long COVID. The most frequent symptoms are fatigue and cognitive dysfunction. We describe a patient suffering from Long COVID in whom adrenal involvement was highlighted. Methods: The patient described Long COVID symptoms that persist 3 months after the negativization of the molecular swab test. The main symptoms were weakness, brain fog, dizziness, and muscular and joint pain. All routine lab panels for inflammation, anemia, and thyroid and liver function were conducted. Moreover, salivary cortisol and DHEA-S determinations were used to compute the adrenal stress index (ASI). Results: All tests were negative, except the ASI that showed very low levels of free cortisol. The patient started hydrocortisone acetate supplementation. Conclusion: Long COVID symptoms could be explained by an adrenal involvement, due to a COVID-19 action on adrenal glands and by a iatrogenic side effect of high glucocorticoid therapy during the COVID-19 infection. Salivary cortisol determination is effective for establishing a correct recovery plan.

Different spectrophotometric methods manipulating ratio spectra for the assay of hydrocortisone acetate and clioquinol in their topical preparation

Simple and precise spectrophotometric methods for quantitative assay of a mixture of hydrocortisone acetate (HCA) and clioquinol (CL) were developed and validated through different mathematical manipulation pathways. The developed methods utilized ratio spectra for resolving binary mixtures including absorbance subtraction, ratio subtraction coupled with spectrum subtraction, constant multiplication, constant value, and derivative ratio. The proposed methods were proved to be specific by analysing the laboratory-prepared mixtures and were applied for the assay of topical preparation successfully. The methods were validated using ICH guidelines where accuracy, repeatability and intermediate precision were within the acceptable limits. The linearity range was found to be 2-22 for HCA and 1.5-7 µg/mL for CL in all proposed methods and 2-7 µg/mL for HCA and CL in absorbance subtraction method through using a unified regression equation. The findings were statistically evaluated with respect to the official and reported methods, demonstrating that there was no significant difference.