The Impact of SARS-Cov-2 Virus Infection on the Endocrine System

Noel Pratheepan Somasundaram; Ishara Ranathunga; Vithiya Ratnasamy; Piyumi Sachindra Alwis Wijewickrama; Harsha Anuruddhika Dissanayake; Nilukshana Yogendranathan; Kavinga Kalhari Kobawaka Gamage; Nipun Lakshitha de Silva; Manilka Sumanatilleke; Prasad Katulanda; Ashley Barry Grossman

Disclosures

J Endo Soc. 2020;4(8) 

In This Article

Abstract and Introduction

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has spread across the globe rapidly causing an unprecedented pandemic. Because of the novelty of the disease, the possible impact on the endocrine system is not clear. To compile a mini-review describing possible endocrine consequences of SARS-CoV-2 infection, we performed a literature survey using the key words Covid-19, Coronavirus, SARS CoV-1, SARS Cov-2, Endocrine, and related terms in medical databases including PubMed, Google Scholar, and MedARXiv from the year 2000. Additional references were identified through manual screening of bibliographies and via citations in the selected articles. The literature review is current until April 28, 2020. In light of the literature, we discuss SARS-CoV-2 and explore the endocrine consequences based on the experience with structurally-similar SARS-CoV-1. Studies from the SARS -CoV-1 epidemic have reported variable changes in the endocrine organs. SARS-CoV-2 attaches to the ACE2 system in the pancreas causing perturbation of insulin production resulting in hyperglycemic emergencies. In patients with preexisting endocrine disorders who develop COVID-19, several factors warrant management decisions. Hydrocortisone dose adjustments are required in patients with adrenal insufficiency. Identification and management of critical illness-related corticosteroid insufficiency is crucial. Patients with Cushing syndrome may have poorer outcomes because of the associated immunodeficiency and coagulopathy. Vitamin D deficiency appears to be associated with increased susceptibility or severity to SARS-CoV-2 infection, and replacement may improve outcomes. Robust strategies required for the optimal management of endocrinopathies in COVID-19 are discussed extensively in this mini-review.

Introduction

Coronavirus disease 2019 (COVID-19), which was first reported in Wuhan, Hubei province, China, toward the end of 2019, swiftly spread around the globe and became a major pandemic.[1] It is caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the seventh coronavirus that is known to cause disease in humans.[2] Within 6 months, the number of deaths globally have exceeded 400 000, resulting in an unprecedented public health emergency in our time.[3]

Because SARS-CoV-2 is a novel virus, limited data are available on the effect of the virus on the endocrine system, including the pancreas. Nevertheless, as the new SARS-CoV-2 is structurally similar to the SARS-CoV-1, studying the pathogenesis and clinical impact of the known disease should be helpful in understanding the possible effects of the novel disease.[4]

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