We have heard about the multi-system failure that could happen due to COVID-19. But are you aware of any endocrinopathies associated with it, like adrenal insufficiency?
I have not heard any association of adrenal insufficiency with COVID19. Have you heard any development as far as this is concerned?
Surviving sepsis campaign guidelines recommend the use of corticosteroid in patients with septic shock refractory to vasopressor. This therefore masks any adrenal insufficiency which may be associated with any cause of sepsis including Covid-19.
With the huge influx of patients it will be difficult for healthcare systems to perform synacthen testing.
Rajkumar Rajendram Thanks for your comment. I agree there will be difficult to perform Synacthen test. However, random cortisol level can be of value to diagnose adrenal insufficiency if the random cortisol level is low when the patient is in severe illness or shock. So we may advocate for checking cortisol level before starting hydrocortisone as per surviving sepsis campaign guideline to see how many of them do come back normal vs low cortisol levels.
Keep well and safe
Dear Ian L Ross
I have not heard of any cases yet, but that could be due under reporting, I am in favour of knowing whether severely unwell patients are being investigated by checking random cortisol level or not?
Hussain Alsaffar I agree that a random cortisol measurement is helpful when screening for adrenal insufficiency. Unfortunately the healthcare system is so overwhelmed at present that the knee jerk response is simply to start hydrocortisone before taking a blood sample as this requires a whole new set of PPE to be donned and doffed.
Lab staff are too overwhelmed to facilitate add on specimens and in some cases are only keeping samples for 24 hours due to lack of storage space.
It is a very challenging time...
Tough times. I hope we could measure the cortisol with the blood gas sample using the gas machine!
Thanks Rajkumar Rajendram anyway for your comments. Wish you all the best.
I am not aware yet of any report of Endocrine Studies or Changes in COVID-19 patients, mostly due to the early phase of disease discovery. But all current responses skewed only in favour of Adrenal Studies (CORTISOL).
However, I have seen reports of significant changes in LIVER, & PANCREATIC ENZYMES, + ADRENAL, RENAL, THYROID, PITUITARY HORMONES, and MALE and FEMALE SEX HORMONES, PANCREATIC HORMONES (MULTIPLE-ENDOCRINE) changes as well as malignant transformation in other viral diseases followed up in a long period especially in the dreaded HIV patients. Other latest but few reports of endocrinopathies even in EBOLA, etc; Therefore, Endocrinopathies as queried may ultimately be likely in COVID-19 in a long run with further studies especially in the survivors. But time may be a major differentiating factor in my opinion.
Dear Bamidele Johnson Alegbeleye ,
Absolutely, time is going to let us learn more about this.
Thanks for your input.
In Saudi Arabia the lock down has resulted in depletion of medications. There is no warfarin available. Antimicrobials are in very short supply. When the thyroxine and hydrocortisone etc are depleted, endocrinopathies will develop...
Shipping charges have increased significantly. The situation is likely to be similar in other countries.
If medications are depleted mortality from non-Covid disease may be increased.
We must urgently determine which medications are effective for this condition to avoid wastage.
Please have a look.
https://www.touchendocrinology.com/insight/covid-19-and-endocrinology-a-bidirectional-relationship/
None has been seen yet at our center yet
few works of literature predicting we may see-
DOI: 10.1056/NEJMc2018688
doi:10.1007/s12020-020-02364-8
Undoubtedly there will be multiple endocrinopathies in both the acute phases of
COVID-19 especially stress related effects on the adrenal as well as other endocrine organs such as in the pancreas and islet cells. such as the following papers:
An Immediate and Long-Term Complication of COVID-19 May Be Type 2 Diabetes Mellitus: The Central Role of beta-Cell Dysfunction, Apoptosis and Exploration of Possible Mechanisms.
Hayden MR. Cells. 2020 Nov 13;9(11):2475. doi: 10.3390/cells9112475
Rubino F., Amiel S.A., Zimmet P., Alberti G., Bornstein S., Eckel R.H., Mingrone G., Boehm B., Cooper M.E., Chai Z., et al. New-Onset Diabetes in Covid-19. N. Engl. J. Med. 2020;383:789–790. doi: 10.1056/NEJMc2018688
I am looking forward to others contributions over time regarding the thyroid and adrenals plus others .
Melvin R Hayden
University of Missouri
Columbia, Missouri
Please take a look at the following RG link.
Article The Impact of SARS-Cov-2 Virus Infection on the Endocrine System
It depends upon the severity of the COVID-19 infection and the immune status of the individual.