Endocrine Abstracts

In December 2019, the outbreak of coronavirus disease (COVID-19) started in Wuhan, China¹, resulting in a global pandemic. A novel coronavirus (SARS-CoV-2) was identified. The virus enters the pneumocyte through the angiotensin-converting enzyme 2 (ACE2) as a receptor². The enzyme is widely expressed. A relationship between COVID-19 and the endocrine system occurs at multiple levels. On autopsies, infarct, edema, and neuronal degeneration with SARS-CoV genoma have been identified in the hypothalamus. Low normal TSH and thyroid hormone levels have been described suggesting a central mechanism related to cytokines. Mortality rate is increased in hipopituitarism mainly due to cardiovascular and cerebrovascular disease, and these are risk factors for COVID-19 disease severity. Hypopituitarism impacts the course and management of COVID-19, specially in the context of adrenal insufficiency. Among the causes of hypopituitarism, pituitary apoplexy should be particularly considered. Adrenal insufficient patients seem not to be at paticular risk of COVID-19; however, they are susceptible to infections, and worse outcomes may be expected. The diagnostic approach does not differ from usual clinical practices. However, face-to-face contact with medical staff and other healthcare professionals should be limited to extremely necessary situations. Central diabetes insipidus may be at risk of more severe dysnatraemia when developing respiratory complications of COVID-19. Dose adjustment of pituitary hormone replacement can be performed by clinical assessment. And if supplies are not available, GH and gonadal replacement can be discontinued for a short time³. In the context of severe COVID illness, hydrocortisone should be adjusted to stress doses and desmopressin should be given parenterally. Education for AI patients is the basis for a better evolution, reminding about sick day management, and adequate supply.

References

1. Fauci AS, Lane HC, Redfield RR. Covid-19- Navigating the uncharted. N Engl J Med 2020; 382: 1268-9.

2. Hamming I, Timens W et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first in understanding SARS pathogenesis. J Pathol 2004; 203: 631-7.

3. Fleseriu M, Dekkers OM, Karavitaki N. Management of Pituitary Tumors. Eur J Endocrinol (2020) 183, G17-G23.