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Direct infection of pituitary or adrenal tissue, direct damage to the adrenal gland or pituitary caused by the immune system due to antibody production and/or cell damage, and inhibition of the HPA axis induced by inflammatory cytokines (functional hypopituarism) ( Supportive of direct infection, angiotensin-converting enzyme 2 (ACE2) is the receptor used by SARS-CoV2 to infect cells and is expressed in a large number of tissues, including the adenohypophysis ( Regarding direct damage due to the immune system, it has been suggested that there is a high molecular similarity between SARS-CoV-2 peptides and human adrenocorticotropic hormone, as in the case of SARS-CoV viral peptides that are structurally similar to adrenocorticotropic hormone (ACTH) ( Finally, in terms of inhibition induced by inflammatory cytokines, chronic exposure to proinflammatory cytokines such as TNF-, could suppress pituitary ACTH secretion and thus, cause relative hypocortisolism during chronic infections ( 3 Hypopituitarism in myalgic encephalomyelitis Something similar could happen in patients with myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), where lower ACTH levels at 6 months after diagnosis of EBV induced infectious mononucleosis were highly predictive of the development of ME/CFS ( In the study by Steiner et al

Massage gently with fingertips for 1-2 minutes to distribute product and stimulate circulation

What assay formats are used to confirm Trevogrumab's neutralizing potency against myostatin-induced signaling