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Review
. 2020 Sep-Oct;24(5):381-386.
doi: 10.4103/ijem.IJEM_440_20. Epub 2020 Nov 9.

Endocrine Involvement in COVID-19: Mechanisms, Clinical Features, and Implications for Care

Mahendra K Garg  1 , Maya Gopalakrishnan  2 , Prakrati Yadav  3 , Sanjeev Misra  4
Affiliations
Review

Endocrine Involvement in COVID-19: Mechanisms, Clinical Features, and Implications for Care

Mahendra K Garg et al. Indian J Endocrinol Metab. 2020 Sep-Oct.

Abstract

Coronavirus 2019 (COVID -19) has rapidly emerged as a global pandemic with multi-system involvement. Involvement of the endocrine system is expected in COVID-19 as the interplay between severe acute respiratory syndrome corona virus-2 (SARS CoV-2) and the endocrine system occurs at multiple levels. The widespread presence of ACE-2 receptors on various tissues suggests scope for direct viral infection. The interactions via the activation of inflammatory mediators and indirect immune-mediated damage are also postulated. Evidence so far suggests that COVID-19 can cause functional hypopituitarism by direct and indirect effects on the hypothalamo-pituitary axis resulting in inappropriate adrenal response to stress. Several reports highlight possible immune-mediated damage to thyroid glands resulting in subacute thyroiditis. COVID-19 is implicated in precipitating hyperglycemia in known diabetics and uncovering insulin resistance in those previously undiagnosed. COVID-19 has also been shown to trigger Type 1 Diabetes with ketosis. Various mechanisms including direct virus-induced beta cell apoptosis and immune-mediated beta-cell damage have been demonstrated. The presence of virus in semen has unclear clinical significance at present. In this mini-review summarize the endocrine manifestations reported so far in COVID-19 disease and explore mechanisms to decipher how SARS CoV-2 may affect various endocrine organs.

Keywords: Adrenal; COVID19; diabetes; endocrine; gonads; hormone; thyroid.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The multi-level interaction between SARS-CoV-2 and the endocrine system. Viral particles may directly infect the endocrine tissues via ACE-2 receptors and cause cytopathology or apoptosis as in the pancreas. Other mechanisms are immune cell/antibody-mediated damage as in subacute thyroiditis. A final mechanism is inflammatory cytokine-mediated dysregulation of the endocrine axis to cause functional hypopituitarism and relative adrenal insufficiency. Clinical features reported so far are marked in green
See this image and copyright information in PMC

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