Current evidence on the impact of the COVID-19 pandemic on paediatric endocrine conditions

Gnocchi, Margherita; D’Alvano, Tiziana; Lattanzi, Claudia; Messina, Giulia; Petraroli, Maddalena; Patianna, Viviana Dora; Esposito, Susanna; Street, Maria Elisabeth

doi:10.3389/fendo.2022.913334

Cited by 11 publications

(15 citation statements)

References 97 publications

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“…did not report any difference in the percentage of abnormal TSH tests in childhood in the 2 periods [ 6 ]. This can be partly explained by the lower spread rate of SARS-CoV-2 infection among the paediatric population [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Differences in the clinical picture at the onset of diagnosis of severe autoimmune hypothyroidism in children depending on the time of diagnosis: before or during the SARS-CoV-2 pandemic

Munarin,

Tuli

2023

pedm

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Introduction There are few data about effects of COVID-19 on thyroid disease presentation in children, due to difficulties in healthcare services access. Aim of the study To assess the differences in hypothyroidism presentation before and during the COVID-19 pandemic. Material and methods All paediatric patients with autoimmune hypothyroidism (AIT) diagnosed from January 2017 to December 2022 were analysed. Results A total of 150 subjects were enrolled (94 in before and 56 during the pandemic period). Severe AIT was detected in 7.4% before and 12.5% during the pandemic. Age at the onset in the pre-pandemic period was lower ( p = 0.04). Diagnosis delay (time elapsed from onset of symptoms and diagnosis) was significantly different between the before and during the pandemic groups ( p = 0.02). In the pre-pandemic period the TSH value was 447.7 ±59.1, and it was 713.7 ±104.4 mUI/l during the pandemic ( p = 0.04), whereas mean fT4 values were 2.66 ±0.34 and 0.58 ±0.08 ng/l, respectively ( p = 0.0002). Significantly greater thyroid volume and bone age delay SDS were observed during the pandemic ( p = 0.04). Neurological symptoms were mostly observed during the pandemic, especially slow speech and impaired school performance. Conclusions A higher rate of severe AIT was observed during the pandemic period, mostly related to difficulties in access to healthcare services. The diagnosis delay led to a more severe biochemical thyroid hormone profile, goitre, and more frequent presence of bone age delay and neurological symptoms at the onset. Recognizing hypothyroidism and recalling symptoms in childhood, even if often non-specific, is fundamental for avoiding diagnosis delay.

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Section: Discussionmentioning

confidence: 99%

Differences in the clinical picture at the onset of diagnosis of severe autoimmune hypothyroidism in children depending on the time of diagnosis: before or during the SARS-CoV-2 pandemic

Munarin,

Tuli

2023

pedm

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“…Since the outbreak of the pandemic, it has been stated that SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2) receptors in the pancreas, possibly damaging islet cells and reducing insulin release[ 13 ], the description of viral infiltration in pancreatic autopsies in patients deceased owing to SARS-CoV-2 infections raised great concern[ 14 , 15 ]. On the other hand, it has been proven that SARS-CoV-2 enters other cells of the endocrine system, such as the thyroid and the gonads, as the ACE2 receptor is also expressed in these tissues[ 16 ]. The selective destruction of the β-cells was initially seen as a contributing factor in the worsening of metabolic control of many diabetic patients during the SARS-CoV-2 infection: In other words, the severe DKA that were observed during and after the infection in adult diabetic patients was supposed to be a clinical indicator of a lack of insulin due to β-cell loss or malfunction[ 17 , 18 ].…”

Section: Epidemiology Of Type 1 Diabetesmentioning

confidence: 99%

Multiple influences of the COVID-19 pandemic on children with diabetes: Changes in epidemiology, metabolic control and medical care

Zucchini¹,

Scozzarella²,

Maltoni³

2023

World J Diabetes

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The coronavirus disease 2019 (COVID-19) pandemic has heavily affected health worldwide, with the various forms of diabetes in children experiencing changes at various levels, including epidemiology, diabetic ketoacidosis rates and medical care. Type 1 diabetes showed an apparent increase in incidence, possibly owing to a direct damage of the virus to the β-cell. Diabetic ketoacidosis also increased in association with the general fear of referring patients to the hospital. Most children with diabetes (both type 1 and type 2) did not show a worsening in metabolic control during the first lockdown, possibly owing to a more controlled diet by their parents. Glucose sensor and hybrid closed loop pump technology proved to be effective in all patients with type 1 diabetes during the pandemic, especially because the downloading of data allowed for the practice of tele-medicine. Telemedicine has in fact grown around the world and National Health Systems have started to consider it as a routine activity in clinical practice. The present review encompasses all the aspects related to the effects of the pandemic on the different forms of diabetes in children.

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“…In the last two decades, increasing attention has been given to the possible effects of exposure to EDCs during pre-natal and early post-natal life, and puberty ( 90 ). EDCs seem to be involved in changes in pubertal timing, although the complexity of exposure in real life makes it difficult to establish a direct causality ( 13 , 14 , 91 – 95 ). In a Belgian retrospective study on 145 patients, detectable concentrations of organochloride pesticides were found in foreign children, both adoptees and immigrants who were referred for CPP, whereas native Belgian children had undetectable serum levels ( 12 ).…”

Section: Precocious Puberty In Adopted Children: Current Data and Hyp...mentioning

confidence: 99%

“…However, most of these hypotheses do not apply to girls presenting with CPP during the covid-19 pandemic ( 13 ). Different hypotheses have been put forward, suggesting both direct and indirect stimulating factors ( 13 , 14 ). However, the underlying mechanisms are uncertain and no one factor can explain the dramatic increase in CPP observed during the covid-19 pandemic in girls.…”

Section: Introductionmentioning

confidence: 99%

Precocious puberty under stressful conditions: new understanding and insights from the lessons learnt from international adoptions and the COVID-19 pandemic

et al. 2023

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Neuro-biological variations in the timing of sexual maturation within a species are part of an evolved strategy that depend on internal and external environmental conditions. An increased incidence of central precocious puberty (CPP) has been described in both adopted and “covid-19 pandemic” children. Until recently, it was hypothesised that the triggers for CPP in internationally adopted children were likely to be better nutrition, greater environmental stability, and improved psychological wellbeing. However, following data collected during and after the coronavirus (COVID-19) global pandemic, other possibilities must be considered. In a society with high levels of child wellbeing, the threat to life presented by an unknown and potentially serious disease and the stressful environment created by lockdowns and other public health measures could trigger earlier pubertal maturation as an evolutionary response to favour early reproduction. The main driver for increased rates of precocious and rapidly progressive puberty during the pandemic could have been the environment of “fear and stress” in schools and households. In many children, CPP may have been triggered by the psychological effects of living without normal social contact, using PPE, being near adults concerned about financial and other issues and the fear of getting ill. The features and time of progression of CPP in children during the pandemic are similar to those observed in adopted children. This review considers the mechanisms regulating puberty with a focus on neurobiological and evolutionary mechanisms, and analyses precocious puberty both during the pandemic and in internationally adopted children searching for common yet unconsidered factors in an attempt to identify the factors which may have acted as triggers. In particular, we focus on stress as a potential factor in the early activation of the hypothalamic-pituitary-gonadal axis and its correlation with rapid sexual maturation.

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Current evidence on the impact of the COVID-19 pandemic on paediatric endocrine conditions

Cited by 11 publications

References 97 publications

Differences in the clinical picture at the onset of diagnosis of severe autoimmune hypothyroidism in children depending on the time of diagnosis: before or during the SARS-CoV-2 pandemic

Differences in the clinical picture at the onset of diagnosis of severe autoimmune hypothyroidism in children depending on the time of diagnosis: before or during the SARS-CoV-2 pandemic

Multiple influences of the COVID-19 pandemic on children with diabetes: Changes in epidemiology, metabolic control and medical care

Precocious puberty under stressful conditions: new understanding and insights from the lessons learnt from international adoptions and the COVID-19 pandemic

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