Atypical presentation of <scp>COVID</scp>‐19 in an older adult: Lethargy and vomiting from severe hypovolemic hyponatremia

Background Despite COVID-19 being identified as severe respiratory viral infection, progressively many relevant endocrine manifestations have been reported greatly contributing to the severity of the clinical presentation. Systemic involvement in COVID-19 is due to the ubiquitous expression of angiotensin-converting enzyme 2 (ACE2) receptor, responsible for the entry in the cells of SARS-CoV-2, Several reports in humans and animal models showed a significant ACE2 mRNA expression in hypothalamus and pituitary cells. Moreover, higher mortality and poorer outcomes have been widely described in COVID-19 patients with obesity, diabetes and vertebral fractures, which are all highly prevalent in subjects with pituitary dysfunctions. Aim To review the main endocrine manifestations of COVID-19 with their possible implications for pituitary diseases, the possible direct and indirect involvement of the pituitary gland in COVID-19, the impact of COVID-19 on the management of established pituitary diseases which can be already at increased risk for worse outcomes and on neurosurgical activities as well as vaccination. Conclusions Our review underlines that there could be a specific involvement of the pituitary gland which fits into a progressively shaping endocrine phenotype of COVID-19. Moreover, the care for pituitary diseases need to continue despite the restrictions due to the emergency. Several pituitary diseases, such as hypopituitarism and Cushing disease, or due to frequent comorbidities such as diabetes may be a risk factor for severe COVID-19 in affected patients. There is the urgent need to collect in international multicentric efforts data on all these aspects of the pituitary involvement in the pandemic in order to issue evidence driven recommendations for the management of pituitary patients in the persistent COVID-19 emergency.

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“…At the beginning of the pandemic, a number of case reports describing hyponatremia of various etiologies was published [67][68][69][70].…”

Section: Hyponatremia-syndrome Of Inappropriate Antidiuretic Hormone Secretion (Siadh)mentioning

confidence: 99%

COVID-19 and the pituitary

et al. 2021

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“…COVID-19 is a disease with widely variable outcomes, among which 19% develop severe disease [2].Adverse clinical outcome correlates with multi-organ injury, maladaptive functions of the renin-angiotensin-aldosterone system and thirst and appetite abnormalities, all of which potentially disrupt water homeostasis [3]. A number of case reports describing hyponatraemia of various etiologies was initially published [4][5][6][7]. Later, a descriptive study of 16 patients with COVID-19-related hospitalization found 50% of them had hyponatraemia [8], whereas the HOPE study, an international registry of 4664 hospitalized COVID-19 patients, found that 20.5% and 3.7% had hyponatraemia and hypernatraemia, respectively [9]: both hyponatraemia and hypernatraemia were generally mild (130-134 mEq/l in 16.7%), severe hyponatraemia (<120 mEq/l) was found only in 0.4%.…”

mentioning

confidence: 99%

Management of hyponatraemia and hypernatraemia during the Covid-19 pandemic: a consensus statement of the Spanish Society for Endocrinology (Acqua Neuroendocrinology Group)

Martinez

Galindo

Ruiz-Sánchez

2021

Rev Endocr Metab Disord

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SARS-COV2 infection has swiftly become a pandemic disease of historic relevance and widely variable outcomes. This variable prognosis is related both to uneven damage, among others, to lungs, heart and kidneys, and to a multisystemic inflammatory reaction. All these factors are known to disrupt water balance and potentially induce hyponatraemia or hypernatraemia. Water balance disorders are known mortality and morbidity risk factors in several clinical scenarios and their proper management, though often complex and hazardous, can reduce mortality and length of hospitalization. Clinical uncertainty over COVID-19 outcome, the variety of organs involved in both the infection and water balance and difficulties in clinical examination due to risk of contagion might obstruct proper management of dysnatremic disorders. Thus, the Acqua Neuroendocrinology Group of the Spanish Society for Endocrinology (SEEN) has endeavoured to provide evidence and expert based recommendations on the management of hyponatraemia and hypernatraemia in COVID-19 patients.

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“…Patient 13 was found to have hypovolemic hyponatremia with a sodium of 106 mmol/L. Several mechanisms have been proposed, one of them being that the virus binds to angiotensin-converting enzyme receptors 6 . This can lead to renal excretion of these electrolytes.…”

Section: Discussionmentioning

confidence: 99%

“…Several mechanisms have been proposed, one of them being that the virus binds to angiotensin-converting enzyme receptors. 6 This can lead to renal excretion of these electrolytes. We believe that the seizure was triggered by the low sodium levels.…”

Section: Discussionmentioning

confidence: 99%