Inusual caso de hiponatremia aguda grave en paciente con infección por COVID-19

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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“…Several reports of hyponatremia at admission in COVID-19 patients all indicate that the low initial levels of plasma sodium could be a risk indicator of severe disease and mortality ( 2 , 3 , 4 , 5 ). Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a common cause of hyponatremia in viral pneumonia, and there are multiple case reports of this neuroendocrinological disturbance in COVID-19 patients ( 6 , 7 , 8 , 9 , 10 ). In SIADH, there is an increased release of AVP, from the posterior lobe of the pituitary, despite normal or low serum osmolality.…”

Section: Introductionmentioning

confidence: 99%

Electrolyte and acid-base imbalance in severe COVID-19

Sjöström

Rysz

Sjöström

et al. 2021

Endocrine Connections

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Acute systemic diseases, such as severe infections, can lead to electrolyte and acid-base alterations. To study the presence of electrolyte imbalance in severe COVID-19, we investigated the frequency and consequences of changes in electrolyte and acid-base patterns over time. We performed a retrospective cohort study including 406 patients with severe COVID-19. Levels of electrolytes, base excess, pH, serum osmolality and hematocrit, the first two weeks of hospitalization, were collected daily from the laboratory database and clinical data from patients’ medical records. We found that hyponatremia was present in 57% of the patients at admission and hypernatremia in 2%. However, within two weeks of hospitalization 42% of the patients developed hypernatremia, more frequently in critically ill patients. Lower levels of sodium and potassium at admission was associated with need of mechanical ventilation. Decreased pH at admission was associated with both death and need of mechanical ventilation. Hypernatremia in the ICU was combined with rising base excess and a higher pH. In the group without intensive care, potassium levels was significantly lower in the patients with severe hypernatremia. Presence of hypernatremia during the first two weeks of hospitalization was associated with 3.942 (95% CI 2.269–6.851) times higher odds of death. In summary, hypernatremia was common and associated with longer hospital stay and a higher risk of death, suggesting that the dynamics of sodium is an important indicator of severity in COVID-19.

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“…It should be noted that up to 60% of SARS-CoV-1 patients had watery diarrhoea associated with mild hyponatraemia, secondary to virus replication within intestinal epithelial cells 13 . Initially, several case reports described the association between syndrome of inappropriate antidiuretic hormone secretion (SIADH) and sodium loss in stool as the most common etiological agents of COVID-19 14 , 15 , 16 . To date, the possible underlying pathophysiological mechanisms are unknown, and it is unclear whether hyponatraemia is caused by a specific involvement of COVID-19 or secondary to the respiratory complication of the infectious condition.…”

Section: Introductionmentioning

confidence: 99%