Endocrine Effects of Covid 19: Difficulties in the Management of Endocrine Disorders from Individual to Societies

Abstract

Development of Covid-19 pandemic infection which started in December 2019 from Wuhan, China, impacted all medical specialities and societies. Endocrine professionals are involved in this battle, as far as many patients with endocrine co-morbidities (diabetes, metabolic syndrome, pituitary, thyroid, adrenal disorders) are most affected by the disease. Specific recommendations for the management of endocrine disorders were released by European experts. Most rely on the same principles of epidemiological safety measures, delaying non emergency admissions and transforming the routine follow-up in telemedicine clinics. Special attention is required to adrenal disorders, either central in the context of pituitary patients or primary. Corticosteroids are a mainstay of treatment in Covid-19 infection, therefore it is important to consider all aspects involved by high doses, including metabolic adverse reactions especially in diabetic patients. Other endocrine disorders, thyroid dysfunctions or nodules, parathyroid, adrenal, and pituitary diseases should follow specific recommendations for management. Surgery is postponed for non-emergency situations, restricting most planned surgeries, either thyroid, pituitary or adrenal. Laparoscopic surgery, if required in emergency, is including a supplementary risk, therefore all involved in the operating theater should wear PPE. In conclusion, a coordinated response should be organized in the multidisciplinary management of endocrine patients.

COVID-19 pandemic and alcohol consumption: Impacts and interconnections

“…Alcohol consumed for long time acts as a stressor on the body and makes it difficult to maintain homeostasis [ 28 , 29 ]. The immediate benefit of alcohol consumption can mask the long-term harmful effect [ 30 , 31 ]. Most often, adults who drink alcohol constantly justify consumption by claiming reducing mental stress, maintaining a state of physical and mental relaxation, but also improving their social behavior [ 32 ].…”

Management of Primary Hyperparathyroidism With Severe Hypercalcemia During the COVID-19 Pandemic

“… 5 However, there is no evidence to suggest that patients with PHPT or hypercalcemia are at increased risk from COVID-19. 1 , 2 , 3 Conversely, hypocalcemia was reported to be a distinctive biochemical feature of COVID-19 that increases disease severity. 6 …”

“…Small doses of IV furosemide should be considered after rehydration. 1 , 2 Second, due to the activation renin-angiotensin-aldosterone system, hypercalcemia management with IV fluids and furosemide could enhance hypokalemia. So, careful monitoring and replacement of potassium are required.…”

“…Finally, flu-like symptoms in the days following IV bisphosphonate administration is a common side effect, and the symptoms may be confused with COVID-19 symptoms. 1 , 2 …”

“…In addition, several statements, advice, and recommendations were issued to guide the management of different medical diseases, including endocrine disorders, during the lockdown and social distancing. 1 , 2 , 3 In patients with primary hyperparathyroidism (PHPT) complicated by significant hypercalcemia, parathyroidectomy remains the only curative therapy. 4 Therefore, the management of these patients during the COVID-19 pandemic represents a challenging clinical situation.…”