Pituitary Disorders and COVID-19, Reimagining Care: The Pandemic A Year and Counting

Fleseriu, Maria

doi:10.3389/fendo.2021.656025

Cited by 10 publications

(21 citation statements)

References 53 publications

(90 reference statements)

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“…More than a year and a half in the pandemic, regular clinical services for patients with pituitary disease are still reduced worldwide [ 130 ]; these delays in both diagnosis and treatment plans could have significant impact on patients’ outcome, morbidity, quality of life and mortality. Telemedicine has been playing an important role, but new management algorithms incorporating intertwined virtual and clinical care are needed.…”

Section: Follow-up Care; Pandemic and Its Aftermathmentioning

confidence: 99%

COVID-19 and hypopituitarism

Frara

Loli

Allora

et al. 2021

Rev Endocr Metab Disord

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Besides the pulmonary manifestations caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), an emerging endocrine phenotype, which can heavily impact on the severity of the syndrome, has been recently associated with coronavirus disease 2019 (COVID-19). Patients with pituitary diseases or the pituitary gland itself may also be involved in COVID-19 clinical presentation and/or severity, causing pituitary apoplexy. Moreover, hypopituitarism is frequently burdened by several metabolic complications, including arterial hypertension, hyperglycemia, obesity and vertebral fractures, which have all been associated with poor outcomes and increased mortality in patients infected by SARS-CoV-2. This review will discuss hypopituitarism as a condition that might have a bidirectional relationship with COVID-19 due to the frequent presence of metabolic comorbidities, to the direct or indirect pituitary damage or being per se a potential risk factor for COVID-19. Finally, we will address the current recommendations for the clinical management of vaccines in patients with hypopituitarism and adrenal insufficiency.

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Section: Follow-up Care; Pandemic and Its Aftermathmentioning

confidence: 99%

COVID-19 and hypopituitarism

Frara

Loli

Allora

et al. 2021

Rev Endocr Metab Disord

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“…Management included organization readjustments and clinical adaptation of the usual practices. [6][7][8][9][10]46,[59][60][61] A summary of the principles and salient practice points for the management of pituitary disorders during the COVID-19 pandemic is presented in Table 5. Some practical aspects are highlighted below.…”

Section: Practical Management Of Pituitary Disease During Covid-19mentioning

confidence: 99%

“…Patients with pituitary disorders should be classified as needing emergent, urgent, or elective care to guide timely intervention [6] Use virtual/telemedicine care to assess and follow stable patients with pituitary disorders [6][7][8][9] Patients with chronic stable pituitary disorders are to be followed less frequently with access to care when needed [6] Patients with pituitary disorders on corticosteroids should be counseled on steroid management if they are infected with COVID-19 or sick after the COVID-19 vaccination [46] Laboratory samples could be collected by the patient at home when possible, e.g., salivary samples instead of blood samples for cortisol assays. However, one visit for laboratory samples collection may be necessary for most patients after proper virtual assessment [9,47] Medical therapy to be utilized when it is an option in place of surgical intervention during the epidemic peak [6] Surgical intervention should be done timely without delay when needed to treat pituitary tumors-maintaining the patients' and healthcare personnel's safety to be ensured through proper COVID-19 screening and applying proper isolation before intervention [48] Known case of pituitary insufficiency on daily HC HC dose was not changed during the infection as the patient was asymptomatic…”

Section: Table 5: Summary Of the Salient Practice Points For Manageme...mentioning

confidence: 99%

“…The care typically involves a multidisciplinary team working in concert to deliver timely, often complex, disease investigation and management, including pituitary surgery. [6][7][8][9][10] COVID-19 has brought about major disruption to the services, limiting access to care and testing, and dramatically reducing the ability to undertake transsphenoidal surgery safely. Therefore, we have reviewed the global literature on the pituitary and COVID-19 to provide a concise thematic account of the subject.…”

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confidence: 99%

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The pituitary gland in the COVID-19 pandemic: A narrative review of the literature

Almalki

Aldahmani

Mahzari

et al. 2021

Journal of Diabetes and Endocrine Practice

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Review Article introduCtion COVID-19 is a novel coronavirus responsible for a pandemic that emerged in December 2019. Heterogeneous clinical forms are described from asymptomatic to severe hypoxaemic acute respiratory syndrome with multisystem organ failure. [1] COVID-19 infection has tremendously impacted social living and clinical practice, education, and research. [2,3] Almost all organs and systems suffer from COVID19 infection. Endocrine conditions are not an exception, and some endocrine organs are at risk of a direct or indirect damage by COVID-19. [4] Endocrine treatment modifications due to COVID-19 infection are required proactively to avoid decompensation and eventual hospital admission. This case was most evident in diabetes and adrenal insufficiency, in which rapid increase of "replacement" therapy is warranted by adopting the appropriate sick day's rules and easy contact with the health care provider through different telematic modalities. [5] The COVID-19 pandemic has had implications in the central nervous system. COVID-19 infection is characterized by coagulation activation and endothelial dysfunction, causing the endocrine system's ischemic and hemorrhagic vascular syndromes. We aimed to provide an overview of the global literature on the impact of COVID-19 on pituitary function and structure. A narrative, nonsystematic review of the literature retrieved from a significant medical online database (PubMed) between February 1, 2020 and June 30, 2021. The relevant literature was narrated in a concise thematic account. Most specific recommendations for managing endocrine disorders during COVID-19 rely on the same principles of epidemiological safety measures, delaying nonemergency admissions and transforming the routine follow-up to telemedicine clinics. Ongoing medications should be continued. Special attention is required to both primary and secondary adrenal disorders. Corticosteroids are a mainstay of treatment in COVID-19 infection. Therefore, it is essential to consider all aspects of high doses, including adverse metabolic reactions, especially in people with diabetes and prediabetes. Surgery is postponed for nonemergency situations, restricting most planned surgeries, and if required in an emergency, plans should include an additional risk. Sick-day rules should be adhered to strictly. Regular contact with endocrinology teams can be maintained through teleconsultations and virtual clinics. In conclusion, special attention is needed to the interaction between COVID-19 infection and pituitary conditions in a bidirectional manner. The direct impact of COVID-19 on pituitary structure and function is possible and should be recognized timely and treated effectively. Furthermore, appropriate organizational adjustments are needed to maintain a coordinated response within the conventional multidisciplinary management to optimize the care of patients with pituitary conditions among the ongoing COVID-19 pandemic.

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“…To date, no cases of de novo pituitary dysfunction have been reported with COVID-19. Patients with pre-existing pituitary disorders have been reported to experience exacerbation of hormonal dysfunction [ 6 ] and pituitary apoplexy when infected with COVID-19[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Optic neuritis concomitant with pituitary macroadenoma in a patient with active COVID-19 infection: A case report

Al-Salihi

Rahman²,

Al-Jebur

et al. 2021

International Journal of Surgery Open

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Introduction and importance Several neuro-ophthalmic manifestations have been reported with coronavirus disease 2019 (COVID-19) infection. However, isolated optic neuritis was infrequently reported in humans with COVID-19. If it occurred, optic neuritis was usually a part of a demyelinating syndrome. Case presentation In this paper, we report a case of optic neuritis concomitant with an undiagnosed pituitary macroadenoma discovered during active COVID-19 infection. The case was a 33-year-old woman with infertility who was recently found to have a pituitary macroadenoma secreting prolactin. During active COVID-19 infection, the patient developed optic neuritis that responded well to corticosteroids. Brain imaging and hormonal profile negated the presence of any demyelinating disease or pituitary apoplexy. Clinical discussion A dilemma of whether optic neuritis occurring concomitantly with pituitary macroadenoma is just a coincidence, or there is an association remains unresolved. Whether COVID-19 infection might precipitate optic neuritis in patients with pituitary macroadenoma or not remains an issue to be answered by observing data from future case reports about similar findings. Conclusion Optic neuritis in concomitant with pituitary macroadenoma following COVID-19 infection represents a dilemma of whether the visual symptoms are attributed to the tumor or COVID-19 infection.

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Pituitary Disorders and COVID-19, Reimagining Care: The Pandemic A Year and Counting

Cited by 10 publications

References 53 publications

COVID-19 and hypopituitarism

COVID-19 and hypopituitarism

The pituitary gland in the COVID-19 pandemic: A narrative review of the literature

Optic neuritis concomitant with pituitary macroadenoma in a patient with active COVID-19 infection: A case report

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