Welcoming you for any type of article submission for the upcoming issue on/before February 26, 2021.

Review Article
Volume 6 Issue 4 - 2021
Acute Catecholamine Surge and Cytokine Storm: The Deadly Duo in Severe COVID-19
Leilani B Mercado-Asis*
Professor, Section of Endocrinology, Department of Medicine, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
*Corresponding Author: Leilani B Mercado-Asis, Professor, Section of Endocrinology, Department of Medicine, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines.
Received: March 24, 2021; Published: March 31, 2021


Catecholamines (norepinephrine, epinephrine, dopamine) are stress hormones which actions are mediated through their adrenoceptors. The multisystem effect of excess secretion of these hormones in severe COVID-19 are manifested variedly as hypertension (cardiovascular and renin-angiotensin systems), marked inflammation and sometimes thrombosis (immune and hematologic systems), hypoxemia and ventilation problem (respiratory system), and hyperglycemia (metabolic and endocrine system). In severe COVID-19, there is systemic hyperinflammation induced by augmented production of proinflammatory cytokines. Such cytokine storm results into multi-organ dysfunction, cardiovascular collapse, and even death. Hypertension, diabetes, obesity, and old age have shown to be risk factors for the untoward events in severe COVID-19. Increased in catecholamine secretion is associated with increase in proinflammatory cytokines. And increased catecholamine levels can augment production of concentrations of proinflammatory cytokines. Takotsubo syndrome is a reversible cardiovascular condition in a setting of physical or emotional stress whereby the excess catecholamines leads to mild to severe myocardial edema. Chronic unabated elevation of these hormones, however, may lead to irreversible cardiomyopathy. Recent reports have shown that there is increased morbidity and mortality in patients with severe COVID-19 and Takotsubo syndrome. The interplay of acute elevation in circulating catecholamines in an already compromised CV function and cytokine storm could influence the clinical course of patients with severe COVID-19. Therefore, early recognition of acute hypercatecholaminergic surge and cytokine storm, so-called the deadly duo, is vital, and a timely and optimal management is critical for increased survival of patients with severe COVID-19.

Keywords: Catecholamines; Chromaffin Tumors; COVID-19; Takotsubo Syndrome; Cytokine Storm; Acute Catecholamine Surge


  1. Mercado-Asis LB., et al. “Evolving clinical presentation and assessment of pheochromocytoma: A review”. Journal of Medicine UST (2017).
  2. Gubbi S., et al. “Catecholamine physiology and its implications in patients with COVID-19”. Lancet Diabetes Endocrinology 8 (2020): 978-986.
  3. Wolff D., et al. “Risk factors for COVID-19 severity and fatality: A structured literature review”. Infection 49 (2021): 15-28.
  4. Chen G., et al. “Clinical and immunological features of severe and moderate coronavirus disease 2019”. Journal of Clinical Investigation 130 (2020): 2620-2629.
  5. Jenkins DE., et al. “Interleukin-6-mediated signaling in adrenal medullary chromaffin cells”. Journal of Neurochemistry 139 (2016): 1138-1150.
  6. De Miguel V., et al. “Catecholamine-induced myocarditis in pheochromocytoma”. Circulation 129 (2014): 1348-1349.
  7. Sanchez-Recalde A., et al. “Pheochromocytoma-related cardiomyopathy inverted Takotsubo contractile pattern”. Circulation 113 (2006): 738-739.
  8. Sharma K., et al. “Takotsubo syndrome a rare entity in COVID-19: A systemic review-focus on biomarkers, imaging, treatment, and outcome”. Springer Nature Comprehensive Clinical Medicine (2021).
  9. Ruffolo R R and Hieble J P. “Adrenoceptor pharmacology: Urogenital applications”. European Urology 36 (1999): 17-22.
  10. Zhong H and Minneman K. “⍺1-Adrenoceptor subtypes”. European Journal of Pharmacology 37 (1999): 5261-5276.
  11. Agryle S A and McGrath J C. “An alpha(1A)/alpha(1L)-adrenoceptor mediates contraction of canine subcutaneous resistance arteries”. Journal of Pharmacology and Experimental Therapeutics 295 (2000): 627-633.
  12. Otusanya O., et al. “A vicious cycle of acute catecholamine cardiomyopathy and circulatory collapse secondary to pheochromocytoma”. Oxford Medical Case Reports 10 (2015): 343-345.
  13. Oberbeck R. “Catecholamines: physiological immunomodulators during health and illness”. Current Medicinal Chemistry 13 (2006): 1979-1989.
  14. Sokolowska M., et al. “Immunology of COVID-19: Mechanisms, clinical outcome, diagnostics, and perspectives-A report of the European Academy of Allergy and Clinical Immunology (EAACI)”. Allergy 75 (2020): 2445-2476.
  15. Titi L., et al. “Fatal Takotsubo syndrome in critical COVID-19 related pneumonia”. Cardiovascular Pathology 51 (2021): 107314.
  16. Japp E A., et al. “Management of 3 cases of pheochromocytoma during the COVID-19 pandemic in New York City: Lessons learned”. Journal of the Endocrine Society 5 (2021): 1-6.
  17. Kemp S F., et al. “Epinephrine: The drug of choice for anaphylaxis- A statement of the World Allergy Organization”. World Allergy Organization Journal S18 (2008).
  18. Derakhshan M., et al. “Possible effect of epinephrine in minimizing COVID-19 severity: A review”. Journal of International Medical Research (2020).
  19. Wang Z., et al. “Recovery from severe-19 H7N9 disease is associated with diverse response mechanisms dominated by CD8+ T cells”. Nature Communications 6 (2015): 1-12.
  20. Konig M F., et al. “Preventing cytokine storm syndrome in COVID-19 using ⍺1 adrenergic receptor antagonists”. Journal of Clinical Investigation 130 (2020): 3345-3347.
  21. Barbieri A., et al. “Can Beta-2-adrenergic pathway be a new target to combat SARS-CoV 2 hyperinflammatory syndrome? – Lessons learned from cancer”. Frontier in Immunology (2020).
  22. Burger A., et al. “Catecholamines stimulate interleukin-6 synthesis in rat cardiac fibroblasts”. American Journal of Physiology-Heart and Circulatory 281 (2001): H14-H21.
  23. Ulhaq Z S and Soraya G V. “Interleukin-6 as a potential biomarker of COVID-19 progression”. Medicine et Maladies Infectieuses 50 (2020): 382-383.
Citation: Leilani B Mercado-Asis. “Acute Catecholamine Surge and Cytokine Storm: The Deadly Duo in Severe COVID-19”. EC Gastroenterology and Digestive System 6.4 (2021): 43-48.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

December Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 19, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.