Endocrinology and Nutrition Service, Department of Medicine, Germans Trias i Pujol Health Science Research Institute and Hospital, Universitat Autònoma de Barcelona, Badalona, Spain.
Department of Endocrinology, Hospital Universitario de la Princesa, Instituto de Investigación de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
Endocrine. 2021 May;72(2):301-316. doi: 10.1007/s12020-021-02734-w. Epub 2021 May 8.
COVID-19 has completely changed our daily clinical practice as well as our social relations. Many organs and biological systems are involved in SARS-Cov-2 infection, either due to direct virus-induced damage or to indirect effects that can have systemic consequences. Endocrine system is not only an exception but its involvement in COVID-19 is so relevant that an "endocrine phenotype" of COVID-19 has progressively acquired clinical relevance.
We have been appointed by the European Society of Endocrinology (ESE) to update with the current statement ESE members and the whole endocrine community on the emerging endocrine phenotype of COVID-19 and its implication for the prevention and management of the disease.
Diabetes has a major role in this phenotype since it is one of the most frequent comorbidities associated with severity and mortality of COVID-19. Careful management including treatment modifications may be required for protecting our patients rather with known diabetes from the most dangerous consequences of COVID-19 or hospitalized with COVID-19, but also in patients with SARS-CoV-2 induced newly onset diabetes. Obesity increases susceptibility to SARS-CoV-2 and the risk for COVID-19 adverse outcome. Adequate nutritional management needs to be granted to patients with obesity or undernourishment in order to limit their increased susceptibility and severity of COVID-19 infection. Lack of vitamin D, hypocalcemia and vertebral fractures have also emerged as frequent findings in the hospitalized COVID-19 population and may negatively impact on the outcome of such patients. Also, in patients with adrenal insufficiency prompt adaptation of glucocorticoid doses may be needed. Moreover, in this updated statement role of sex hormones as well as peculiar pituitary and thyroid aspects of COVID-19 have been included. Finally, in view of the mass vaccination, potential implications for endocrine patients should be considered.
COVID-19 彻底改变了我们的日常临床实践和社会关系。许多器官和生物系统都参与了 SARS-CoV-2 感染，这要么是由于直接的病毒诱导损伤，要么是由于可能产生全身性后果的间接影响。内分泌系统不仅是一个例外，而且其在 COVID-19 中的参与程度如此之高，以至于 COVID-19 逐渐出现了“内分泌表型”。
我们受欧洲内分泌学会 (ESE) 的委托，用当前的声明更新 ESE 成员和整个内分泌学界对 COVID-19 新兴内分泌表型的认识，以及它对疾病预防和管理的影响。
糖尿病在这种表型中起着重要作用，因为它是与 COVID-19 的严重程度和死亡率最相关的最常见合并症之一。为了保护我们的患者，包括治疗调整在内的精心管理可能是必要的，以防止已知患有糖尿病的患者受到 COVID-19 的最危险后果的影响，或者防止 COVID-19 住院患者的病情恶化，但也要防止 SARS-CoV-2 引起的新发糖尿病患者的病情恶化。肥胖增加了感染 SARS-CoV-2 和 COVID-19 不良后果的风险。需要给予肥胖或营养不良患者适当的营养管理，以限制他们感染 COVID-19 的易感性和严重程度增加。维生素 D 缺乏、低钙血症和椎体骨折也已成为住院 COVID-19 患者的常见发现，可能对这些患者的预后产生负面影响。此外，对于肾上腺功能不全患者，可能需要及时调整糖皮质激素剂量。此外，在本更新声明中，还包括了性激素以及 COVID-19 中独特的垂体和甲状腺方面的作用。最后，鉴于大规模接种疫苗，应该考虑对内分泌患者的潜在影响。
