There are more than 170 million confirmed cases of COVID-19 worldwide, yet its effects on the endocrine system remain under-reported due to lack of awareness by the public, primary care givers and specialists. This is a narrative review using up-to-date literature discussing the consequences that infection with SARS-CoV-2 can have on diabetes and the endocrine glands including the adrenals, thyroid and pituitary, as well as hyponatremia and hypogonadism. Endocrinologists, internists and primary care physicians need to be aware of the involvement of the endocrine organs when dealing with people recovering from COVID-19 and actively manage any complications to reduce mortality and improve the quality of life of those affected.

The COVID-19 pandemic is revealing growing reports of atypical presentation of the disease beyond the respiratory system. SARS-CoV-2 infection has been linked to multisystem vasculopathy including cardiopulmonary, cerebral and renal vasculature, potentially brought on by a dysregulated host immune response in a probable setting of a cytokine storm. Here, we describe a case of a previously healthy and active 74-year-old man presenting with acute cognitive decline with preceding non-specific influenza-like symptoms. He was then diagnosed with cerebral amyloid angiopathy (CAA)-associated intracerebral haemorrhage and was found to be COVID-19 positive. COVID-19-induced immune response may have further compromised the cerebral vessels already weakened by CAA, triggering multiple microhaemorrhages leading to clinical presentation. The limited evidence about the heterogeneity of COVID-19 manifestations suggests that clinicians should be aware and screen for concurrent COVID-19 in patients presenting with neurological features during the peak of this pandemic, as this offers the best chance for better clinical outcome.

COVID-19 vaccines have been shown to be highly efficacious in preventing symptomatic COVID-19 infections throughout the pandemic. There have been emerging cases of inflammatory arthritis occurring in close relation to COVID-19 vaccination. We illustrate a case of new-onset inflammatory arthritis 10 days after receiving their second Vaxzevria COVID-19 vaccine. The patient responded dramatically to prednisolone treatment but subsequently required hydroxychloroquine due to persistent inflammatory joint symptoms. Inflammatory arthritis is an increasingly recognized rare adverse effect of COVID-19 vaccination and clinicians should actively consider this in patients with new or flares of inflammatory joint disease.

A 60-year-old woman with type 1 diabetes mellitus, past history of breast cancer, degenerative disc disease, hypothyroidism and asthma gave a 5-day history of flaccid paralysis and a 5-month history of back pain and worsening mobility. Investigations revealed hypercalcemia, hyperkalemia and hyponatremia which were initially thought to be due to hypercalcemia of malignancy on the assumption that her breast cancer had recurred. Imaging of the spine did not reveal cauda equina syndrome. There was no clinical and biochemical improvement in spite of fluid resuscitation. Hypoadrenalism was suspected and confirmed three days later. Adrenal replacement therapy fully resolved her paralysis within 24 hours. Addison’s disease is a rare clinical entity that requires a high index of suspicion. It may rarely present with weakness and/or back pain. Early recognition and treatment of Addison’s disease adequately resolves hyperkalemic paralysis. It is good clinical practice to keep an open-ended differential list to help reduce diagnostic suspicion bias.

A 59‐year‐old gentleman was admitted with diabetic ketoacidosis (DKA). His medication history included a sodium‐glucose co‐transporter 2 (SGLT2) inhibitor for the past six years. Relevant history includes undertaking a low‐carbohydrate diet for four months.In hospital he required a fixed rate insulin infusion for 25 hours and variable rate insulin infusion for a total of 32 hours to manage his ketonaemia. He received concomitant dextrose infusion and oral nutritional supplements throughout the course of his admission to replenish the likely depleted glycogen stores in his liver as a result of his diet.The case highlights the importance of identifying DKA early and treating the underlying cause. It also highlights the potential increasing prevalence of ketoacidosis which may occur as more patients are prescribed SGLT2 inhibitors and adhere to carbohydrate‐restricted diets. Copyright © 2023 John Wiley & Sons.