Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Rev Endocr Metab Disord. 2022 Apr;23(2):299-308. doi: 10.1007/s11154-021-09655-z. Epub 2021 Apr 13.
COVID-19 extra-pulmonary features include several endocrine manifestations and these are becoming strongly clinically relevant in patients affected influencing disease severity and outcomes.At the beginning of COVID-19 pandemic no population data on calcium levels in patients affected were available and in April 2020 a first case of severe acute hypocalcemia in an Italian patient with SARS-CoV-2 infection was reported. Subsequently, several studies reported hypocalcemia as a highly prevalent biochemical abnormality in COVID-19 patients with a marked negative influence on disease severity, biochemical inflammation and thrombotic markers, and mortality. Also a high prevalence of vertebral fractures with worse respiratory impairment in patients affected and a widespread vitamin D deficiency have been frequently observed, suggesting an emerging "Osteo-Metabolic Phenotype" in COVID-19.To date, several potential pathophysiological factors have been hypothesized to play a role in determining hypocalcemia in COVID-19 including calcium dependent viral mechanisms of action, high prevalence of hypovitaminosis D in general population, chronic and acute malnutrition during critical illness and high levels of unbound and unsaturated fatty acids in inflammatory responses.Since hypocalcemia is a frequent biochemical finding in hospitalized COVID-19 patients possibly predicting worse outcomes and leading to acute cardiovascular and neurological complications if severe, it is reasonable to assess, monitor and, if indicated, replace calcium at first patient hospital evaluation and during hospitalization.
COVID-19 的肺外表现包括多种内分泌表现，这些表现对受影响的患者的疾病严重程度和结果产生了强烈的临床影响。在 COVID-19 大流行开始时，尚无受影响患者钙水平的人群数据，2020 年 4 月报道了首例意大利 SARS-CoV-2 感染严重急性低钙血症病例。随后，几项研究报告了 COVID-19 患者中低钙血症是一种高度普遍的生化异常，对疾病严重程度、生化炎症和血栓形成标志物以及死亡率有明显的负面影响。同样，经常观察到受影响患者的椎体骨折发生率较高且呼吸功能受损更严重，以及广泛的维生素 D 缺乏，这表明 COVID-19 中出现了一种新兴的“骨代谢表型”。迄今为止，已经假设了几种潜在的病理生理因素在决定 COVID-19 中的低钙血症中起作用，包括钙依赖性病毒作用机制、一般人群中维生素 D 缺乏症的高患病率、危重病期间的慢性和急性营养不良以及炎症反应中未结合和不饱和脂肪酸的高水平。由于低钙血症是住院 COVID-19 患者中常见的生化发现，可能预示着更差的结局，并在严重时导致急性心血管和神经系统并发症，因此在首次患者入院评估和住院期间评估、监测和在需要时替代钙是合理的。
