Endocrine Flawed In COVID-19 Era

Abstract

The clinical practice and social relationships have been changed since the emergence of COVID-19. It is declared a global pandemic affecting millions of people across the world. SARS-CoV-2 virus while infecting human has been noted to affect several vital organs and biological systems. This can occur directly through virus-induced damage or indirectly due to the host response after virus entry, which produce a negative impact on body systems. Human endocrine system similar fatal effect. Thereafter, the knowledge and clinical expertise about the management of the endocrine pathological consequences of COVID-19 is essential in the current pandemic situation. The need of such clinical proficiency is increasing more demanding as SARS-CoV-2 pandemic is growing towards more devastating phase. The coronavirus enters the human body by using the angiotensin converting enzyme 2 (ACE-2). Other than the pneumocytes, ACE-2 is expressed by several endocrine glands like the pancreas, pituitary gland, adrenal glands, thyroid, ovary, and testes. Diabetes has a significant impact on covid 19. Diabetes Mellitus is one of the comorbidities most frequently linked to severity and mortality resulting from COVID-19 infection. Thus, careful management that includes modification of treatment may be needed to protect from the most dangerous outcomes of the virus infection or hospitalization with COVID-19, not only for patients with a known history of diabetes but also those suffering SARS-CoV-2 induced new-onset diabetes. Those suffering from obesity are more susceptible to SARS-CoV-2 as well as to adverse effects. In order to limit the susceptibility and severity of SARS-CoV-2 infection, there needs to be adequate management of nutrition of obese and undernourished patients. Hypothalamic-pituitary axis suppression, adrenal insufficiency, thyroid dysfunction, hypocalcemia, vitamin D lack, and vertebral fractures have also been reported as frequent findings in COVID-19 infected individuals who needed to be hospitalized and often associated with fatal clinical outcomes. Prompt glucocorticoid adjustment is also required in patients with COVID-19 having adrenal insufficiency. Addressing hormonal status may limit further treatment burden for a COVID-19 infected patient. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.49-64

Obesity inflicted reproductive complications and infertility in men

“…Such complications create an environment of chronic inflammation and release of inflammatory cytokines 80,81 . Growth factors, hormones, adipokine, and cytokines link obesity to dysfunctions of several body systems includingthe reproductive system 82 . Male infertility resulting from obesity involves various molecular pathways and creates a hormonal imbalance that hampers sperm production.…”

​Key findings regarding COVID 19 in Bangladesh and wider and their implications

“…There are concerns with COVID-19 in both obese and undernourished patients, with co-morbidities with diabetes known to increase mortality in patients with COVID-19 58,59 . Akter et al in their paper stress that there needs to be adequate management of these patients to limit the susceptibility and severity of COVID-19 including potential modification of treatment where pertinent 59 . Prompt glucocorticoid adjustments are also required in patients with COVID-19 suffering from adrenal insufficiency 59 .…”

“…Akter et al in their paper stress that there needs to be adequate management of these patients to limit the susceptibility and severity of COVID-19 including potential modification of treatment where pertinent 59 . Prompt glucocorticoid adjustments are also required in patients with COVID-19 suffering from adrenal insufficiency 59 .…”

Angiotensin converting enzyme 2 in the gastrointestinal tract: binding with coronavirus and its consequences

“…Other than the lung alveolar cells, ACE2 and transmembrane serine protease 2 (TMPRSS2) are expressed in several cells like the pancreas, pituitary gland, adrenal glands, thyroid, ovarytestesand the gastrointestinal (GI) epithelium 2 .In the GI tract, ACE2 mRNA and protein are highly expressed in the small intestinal enterocytes but not in the goblet cells or intestinal immune cells 3,4 . ACE2has been identified as the cellular bindingsite for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),the causative agent of COVID-19 5 .…”

“…Attachment of the virus to ACE2 triggers the internalization of the ACE2-virus complex into the target cell, leading to the downregulation of ACE2 7 . Alteration of the expression of ACE2 in different systems might contribute to increase in COVID-19 related morbidity and mortality 2,8,9 .…”