For most, exposure to SARS-CoV-2 lasts up to 3 weeks, with symptoms ranging from asymptomatic to severe. However, there is a subset of exposed patients that have presented long-term symptoms ranging from decreased cardiopulmonary functionality to brain fog. This subset, referred to as long haulers, has manifested symptoms for as long as 9 months.
Researcher, Maram Hashim, and her colleagues have published a report in BMJ analyzing a case report of a long-hauler patient who presented adrenal insufficiency. This marks a potential mechanism of the brain fog induced by SARS-CoV-2. The adrenal glands are located on top of the kidneys and are responsible for producing hormones that regulate the immune system, stress response and other vital functions. One of the hormones created is cortisol, a glucocorticoid steroid that acts as your natural alarm system. It's key in the management of the fight or flight response.
Adrenal insufficiency is the impairment of the adrenal gland. Hashim points out that SARS-CoV-2 has a wide range of organ systems it infects due to the ubiquitous nature of the ACE-2 receptors it binds to. In their case report, they show that the infection targeted adrenal function using cortisol testing. Symptoms appeared to be transient in nature, but for many, there could be an impairment that lasts much longer. This could be a potential mechanism for the brain fog experienced by many post-infection. Further research is needed to determine how prevalent the adrenal glands are being targeted, but the good news is most adrenal insufficiency patients recover full functionality. Current treatment involves the use of synthetic steroids, like prednisone, to manage low cortisol levels.
Image credit: CDC