COVID-19 and the Endocrine System: A Review of the Current Information and Misinformation

Mirza, Samir; Sheikh, Abdul Ahad Ehsan; Barbera, Michaela; Ijaz, Zainab; Javaid, Muhammad Ali; Shekhar, Rahul; Pal, Suman; Sheikh, Abu Baker

doi:10.3390/idr14020023

Cited by 40 publications

(32 citation statements)

References 92 publications

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“…Other collateral elements might be autoimmune conditions of endocrine and non-endocrine type, liver anomalies (including of coagulation factors), antiphospholipid syndrome (APLS); endothelial dysfunction in severe shock accompanying coronavirus infection has been described including in pediatric population [60,61]. Endothelial injury, inflammation and hypoxia may similarly cause myocardial infarction [62][63][64]. Most probably, the fact that COVID-19 infection induced positive antiphospholipid antibodies represents the key element which was also described in patients without coronavirus infection [65].…”

Section: Contributor Factorsmentioning

confidence: 99%

COVID-19 infection: from stress-related cortisol levels to adrenal glands infarction

Popescu

Terzea²,

Cârșote³

et al. 2022

Rom J Morphol Embryol

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Cortisol is a key element in acute stress including a severe infection. However, in coronavirus-associated disease, 20% of subjects experience hypocortisolemia due to direct or immune damage of pituitary and adrenal glands. One extreme form of adrenal insufficiency is found in 2/3 of cases with viral and post-viral adrenal infarction (AI) (with/without adrenal hemorrhage) that is mostly associated with a severe coronavirus disease 2019 (COVID-19) infection; it requires prompt glucocorticoid intervention. Some reports are incidental findings at computed tomography (CT)/magnetic resonance imaging (MRI) scans for non-adrenal complications like pulmonary spreading and others are seen on post-mortem analysis. This is a review of PubMed-accessible, English papers focusing on AI in addition to the infection, between March 1, 2020 and November 1, 2021. Exclusion criteria were acute adrenal insufficiency without the histopathological (HP) and/or imaging report of adrenal enlargement, necrosis, etc., respective adrenal failure due to pituitary causes, or non-COVID-19-related adrenal events. We identified a total of 84 patients (different levels of statistical evidence), as follows: a retrospective study on 51 individuals, two post-mortem studies comprising nine, respectively 12 patients, a case series of five subjects, seven single-case reports. HP aspects include necrosis associated with ischemia, cortical lipid degeneration (+/-focal adrenalitis), and infarcts at the level of adrenal cortex, blood clot into vessels, acute fibrinoid necrosis in arterioles and capsules, as well as subendothelial vacuolization. Collateral potential contributors to adrenal damage are thrombotic events, coagulation anomalies, antiphospholipid syndrome, endothelial dysfunction, severe COVID-19 infection with multiorgan failure, etc. Clinical picture is variable from acute primary adrenal insufficiency to asymptomatic or mild evolution, even a retrospective diagnostic; it may be a part of long COVID-19 syndrome; glucocorticoid therapy for non-adrenal considerations might mask cortisol deficient status due to AI/hemorrhage. Despite its rarity, the COVID-19-associated AI/hemorrhage represents a challenging new chapter, a condition that is essential to be recognized due to its gravity since prompt intervention with glucocorticoid replacement is lifesaving.

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Section: Contributor Factorsmentioning

confidence: 99%

COVID-19 infection: from stress-related cortisol levels to adrenal glands infarction

Popescu

Terzea²,

Cârșote³

et al. 2022

Rom J Morphol Embryol

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“…SARS-CoV-2 affects most endocrine glands including the pancreas, thyroid, and adrenal glands [Lundholm et al 2020]. The viral pathogen could affect endocrine system through various routes (i.e., direct viral injury, immunological and inflammatory damage) in emerging new-onset metabolic syndromes such as the development of type 1 diabetes mellitus, worsening of glycemic control (in pre-existing type 2 diabetes mellitus), primary Leydig cell damage, critical illness-related corticosteroid insufficiency, central hypocortisolism, pituitary apoplexy, immunemediated hypophysitis, diabetes insipidus, sick-euthyroid syndrome, subacute thyroiditis, and bone demineralization with enhanced fracture risk [ Host metabolic targets for endocrine re-optimization: ACE2 receptors are expressed in various endocrine tissues; thus, making the system a vulnerable target for SARS-CoV-2 infection [Lazartigues et al 2020, Mirza et al 2022]. In endocrine system, ACE2 are localized in the paraventricular nucleus of hypothalamus [Chigr et al 2020], in the acidophilic cells of parathyroid glands [He et al 2006], in the pancreatic ductal, acinar and islet cells , and co-expressed with TMPRSS2 in thyroid [Rotondi et al 2021] and adrenocortical cells [Mao et al 2021].…”

Section: Endocrine Impairments In Pascmentioning

confidence: 99%

“…include vaccine-associated thrombosis and thrombocytopenia (TTS) with adrenal hemorrhage, derangements in glycemic control including new onset type 2 diabetes mellitus, and subacute thyroiditis[Mirza et al 2022]. TTS is a serious but rare adverse event associated with exposure to adenovirus vector vaccines Ad26.COV2.S and ChAdOx1 nCoV-19 has raised immunization safety concerns [Long et al 2021, See et al 2021].…”

mentioning

confidence: 99%

SARS-CoV-2-induced host metabolic reprogram (HMR): nutritional interventions for global management of COVID-19 and post-acute sequelae of COVID-19 (PASC)

Naidu¹,

Shahidi²,

Wang³

et al. 2022

Journal of Food Bioactives

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‘Severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2) is a highly transmissible viral pathogen responsible for the ongoing ‘coronavirus disease 2019’ (COVID-19) pandemic. The current re-purposed antiviral interventions against SARS-CoV-2 are classified into two major groups: Group-1 represents the family of drugs, mainly the vaccines that directly target the virus, and Group-2 includes a specific class of inhibitors that interfere with the host-cell machinery, which is critical for viral infection and replication. Global efforts to control COVID-19 pandemic with vaccines and repurposed therapeutics represent only a phased victory. The emergence of several SARS-CoV-2 variants of concern (VOCs) has compromised several vaccinations and pharma-therapeutic protocols, which highlights the dire necessity for specific antiviral interventions that target highly conserved domains, which are less likely to mutate in the SARS-CoV-2 genome. Several bioactive phytochemicals that block viral enzymes such as nsp5/main proteinase (Mpro) and RNA-dependent nsp7/nsp8/nsp12 RNA-dependent RNA-polymerase (RdRp) complex, are extensively investigated in this direction. The SARS-CoV-2 infection triggers a complex human host-pathogen interaction(s) resulting in ‘host metabolic reprogramming’ (HMR), iron (Fe)-redox dysregulation (FeRD), and altered mitochondrial function that cumulatively disrupt several metabolic pathways involved in cellular energy and antioxidant enzyme function; thereby, compromise the innate host defense. The circulatory/RAAS axis contributes to FeRD and any alteration or imbalance in the Fe-redox homeostasis (Fe-R-H) may lead to ‘new onset’ metabolic disorders (i.e., diabetes). Such inherent body damage and its long-term health consequences in post-acute sequelae of COVID-19 (PASC) require effective nutritional intervention strategies, particularly at the interface of organ system functions and immune system dynamics. The long-term sequelae of PASC indicate an accelerated rate of immune exhaustion in COVID-19 patients, due to prolonged antigen stimulation (also due to vaccine exposure). Abnormal immune metabolism may also cause systemic perturbations (i.e., FeRD), ROS/RNS production, oxidative and nitrosative stress, which could trigger multi-organ disorders ranging from mild symptoms to an incapacitating state and reduced quality of life that could last for weeks or longer following recovery from COVID-19. The five most long-term clinical manifestations of PASC include fatigue, headache, attention disorder, hair loss, and dyspnea. This narrative review elucidates the intricate impairments and sequelae associated with eight major physiological systems in COVID-19 survivors (i.e., pulmonary, neuro-cognitive, cardiovascular, renal, gastrointestinal/hepato-biliary, endocrinal, skeleton-muscular, and reproductive) – triggered by the FeRD, amplified by the HMR, altered mitochondrial function and ACE2/RAAS axis. We have attempted to explain the ongoing epidemic of the residual, non-viral host metabolic disorders and complications in COVID-19 survivors and the supportive role of specific host system-targeted nutritional interventions such as natural plant-based anti-inflammatories, immune-modulators, antioxidants, and macro-/micronutrient metabolic optimizers to manage PASC, the newly emerged post-COVID metabolic syndrome.

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“…Einige Fallpublikationen der letzten 2 Jahre berichten über das akute Auftreten eines Hypophysenapoplexes 3 8 bzw. die Manifestation einer Adeno- oder auch Neurohypophysen-Insuffizienz 9 10 im zeitlichen Zusammenhang mit COVID-19. Ob es sich hierbei um eine kausale oder doch eher koinzidentelle Assoziation in Anbetracht der global hohen Infektionszahlen handelt, lassen die Fallberichte noch unbeantwortet.…”

Section: Covid-19 Und Störungen Der Wasser- Und Natriumhomöostaseunclassified

SIADH & Diabetes insipidus: Neues zu Diagnosestellung und Therapie

Fenske¹,

Charlotte²

2022

Dtsch Med Wochenschr

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Was ist neu? COVID-19 und Störungen der Wasser- und Natriumhomöostase Eine Dysnatriämie tritt bei hospitalisierten Patient*innen mit COVID-19 gehäuft auf und ist mit einer erhöhten Mortalität und vermehrt septischen Verläufen assoziiert. Insbesondere eine profunde Hyponatriämie kann auch Ausdruck für ein zugrunde liegendes Syndrom der inadäquaten AVP-Sekretion (SIADH) oder einen Cortisolmangel unter COVID-19-Infektion sein. Patient*innen mit bereits bekannten Störungen des AVP-Systems – wie dem SIADH oder Diabetes insipidus – sind einem erhöhten Risiko einer mitunter schwerwiegenden Elektrolyt-Entgleisung unter COVID-19-Infektion ausgesetzt und sollten engmaschig kontrolliert werden. Hyponatriämie unter Immun-Checkpoint-Blockade – nicht immer SIADH Der wachsende Einsatz von Immun-Checkpoint-Inhibitoren (ICI) in der Tumortherapie hat auch zu einem Zuwachs von immunvermittelten endokrinen Nebenwirkungen geführt. Diese können zeitlich sehr variabel, auch noch nach Beendigung einer ICI-Therapie, auftreten und initial eine unspezifische Klinik aufweisen. Als ein einfacher, allgemein verfügbarer Biomarker und zugleich sensitives Warnsignal für mögliche endokrine Nebenwirkungen kann die Hyponatriämie dienen. Eine unklare und neu aufgetretene Hyponatriämie unter ICI-Therapie sollte vor Diagnose eines SIADH stets abgeklärt und endokrine Nebenwirkungen sollten ausgeschlossen werden. Neue Evidenz in der Behandlung der akuten und chronischen Hyponatriämie In der Behandlung der akuten symptomatischen Hyponatriämie eignen sich sowohl die rasche intermittierende Bolusgabe als auch die langsam kontinuierliche Infusion von 3 % NaCl zur Akuttherapie. Die Bolusgabe bietet eine geringe Überlegenheit im Sicherheitsprofil und wird in den Empfehlungen der Europäischen Praxisleitlinie favorisiert. In der Behandlung der chronischen Hyponatriämie bei SIADH ist die Flüssigkeitsrestriktion als Erstlinientherapie ein probates Mittel zur Elektrolyt-Korrektur. Die additive Gabe von Furosemid und NaCl-Kapseln zeigt keine gesteigerte Wirkeffizienz, jedoch eine schlechtere Verträglichkeit. Copeptin-basierte Diagnostik in der Abklärung des Polyurie-Polydipsie-Syndroms Bei der Abklärung des Polyurie-Polydipsie-Syndroms ist die Sicherung einer hypotonen Polyurie vor der erweiterten diagnostischen Differenzierung essenziell. Copeptin-basierte Testverfahren zeigen eine deutliche Überlegenheit gegenüber dem indirekten Durstversuch in der Differenzierung zwischen Patient*innen mit einem Diabetes insipidus und einer Primären Polydipsie. Das eskalierende Vorgehen der diagnostischen Verfahren ist ebenso zielführend wie ressourceneffizient.

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COVID-19 and the Endocrine System: A Review of the Current Information and Misinformation

Cited by 40 publications

References 92 publications

COVID-19 infection: from stress-related cortisol levels to adrenal glands infarction

COVID-19 infection: from stress-related cortisol levels to adrenal glands infarction

SARS-CoV-2-induced host metabolic reprogram (HMR): nutritional interventions for global management of COVID-19 and post-acute sequelae of COVID-19 (PASC)

SIADH & Diabetes insipidus: Neues zu Diagnosestellung und Therapie

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