Unit of Paediatrics, Department of Medicine and Surgery, University of Parma, and University Hospital of Parma, Parma, Italy.
Front Endocrinol (Lausanne). 2022 Aug 5;13:913334. doi: 10.3389/fendo.2022.913334. eCollection 2022.
Severe acute respiratory coronavirus 2 (SARS-CoV-2) interacts with the host cells through its spike protein by binding to the membrane enzyme angiotensin-converting enzyme 2 (ACE2) and it can have a direct effect on endocrine function as ACE2 is expressed in many glands and organs with endocrine function. Furthermore, several endocrine conditions have features that might increase the risk of SARS-CoV-2 infection and the severity and course of the infection, as obesity for the underlying chronic increased inflammatory status and metabolic derangement, and for the possible changes in thyroid function. Vitamin D has immunomodulatory effects, and its deficiency has negative effects. Adrenal insufficiency and excess glucocorticoids affect immune conditions also besides metabolism. This review aims to analyze the rationale for the fear of direct effects of SARS-Cov-2 on endocrinological disorders, to study the influence of pre-existing endocrine disorders on the course of the infection, and the actual data in childhood. Currently, data concerning endocrine function during the pandemic are scarce in childhood and for many aspects definite conclusions cannot be drawn, however, data on properly managed patients with adrenal insufficiency at present are re-assuring. Too little attention has been paid to thyroid function and further studies may be helpful. The available data support a need for adequate vitamin D supplementation, caution in obese patients, monitoring of thyroid function in hospitalized patients, and confirm the need for an awareness campaign for the increased frequency of precocious puberty, rapidly progressive puberty and precocious menarche. The changes in lifestyle, the increased incidence of overweight and the change in the timing of puberty lead also to hypothesize that there might be an increase in ovarian dysfunction, as for example polycystic ovarian disease, and metabolic derangements in the next years, and in the future we might be facing fertility problems. This prompts to be cautious and maintain further surveillance.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）通过其刺突蛋白与宿主细胞相互作用，通过与膜酶血管紧张素转换酶 2（ACE2）结合，它可以直接影响内分泌功能，因为 ACE2 在具有内分泌功能的许多腺体和器官中表达。此外，一些内分泌疾病的特征可能会增加 SARS-CoV-2 感染的风险，以及感染的严重程度和病程，如肥胖症的潜在慢性炎症状态和代谢紊乱，以及甲状腺功能的可能变化。维生素 D 具有免疫调节作用，其缺乏会产生负面影响。肾上腺功能不全和糖皮质激素过多除了影响代谢外，还会影响免疫状况。本综述旨在分析对 SARS-CoV-2 对内分泌疾病的直接影响的担忧的合理性，研究现有的内分泌疾病对感染过程的影响，以及儿童的实际数据。目前，儿童时期关于内分泌功能的疫情数据很少，对于许多方面都无法得出明确的结论，但是，目前关于适当管理的肾上腺功能不全患者的数据令人放心。对于甲状腺功能的关注还不够，进一步的研究可能会有所帮助。现有数据支持需要适当补充维生素 D，对肥胖患者要谨慎，对住院患者的甲状腺功能进行监测，并确认需要开展提高性早熟、快速进展性青春期和早熟月经初潮的频率的宣传活动。生活方式的改变、超重发病率的增加以及青春期时间的改变也使人们假设可能会出现卵巢功能障碍，例如多囊卵巢疾病，以及未来几年的代谢紊乱，我们可能会面临生育问题。这促使人们保持谨慎并进行进一步的监测。
