text: Possible Adrenal Involvement in Long COVID Syndrome i Background i 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 i Methods i 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 i Results i All tests were negative except the ASI that showed very low levels of free cortisol The patient started hydrocortisone acetate supplementation i Conclusion i 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 