Endocrine involvement in COVID-19: Mechanisms, clinical features, and implications for care

Mahendra K Garg; Maya Gopalakrishnan; Prakrati Yadav; Sanjeev Misra

doi:10.4103/ijem.IJEM_440_20

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Year : 2020 | Volume : 24 | Issue : 5 | Page : 381-386

Endocrine involvement in COVID-19: Mechanisms, clinical features, and implications for care

Mahendra K Garg¹, Maya Gopalakrishnan², Prakrati Yadav³, Sanjeev Misra⁴
¹ Professor, Department of Medicine and Endocrinology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
² Assistant Professor, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
³ Resident Doctor, Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
⁴ Director and Chief Executive Officer, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Correspondence Address:
Mahendra K Garg
Department of Medicine and Endocrinology, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijem.IJEM_440_20

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.

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