Savvidis Christos, Rizzo Manfredi, Ilias Ioannis
Department of Endocrinology, Hippokration General Hospital, 11527 Athens, Greece.
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, 90127 Palermo, Italy.
Medicina (Kaunas). 2025 May 15;61(5):899. doi: 10.3390/medicina61050899.
Mpox (MPX), caused by the Monkeypox virus (MPXV), is a zoonotic orthopoxvirus infection with increasing global relevance due to sustained human-to-human transmission. While primarily known for cutaneous and systemic involvement, emerging evidence suggests that MPX may also disrupt endocrine function. This narrative review aims to synthesize current clinical, experimental, and epidemiological findings on MPX-related endocrine complications. We explore the potential impact of MPXV on the thyroid, adrenal glands, and gonads, and discuss the underlying mechanisms, clinical manifestations, and implications for patient management. MPX has been implicated in viral-induced subacute thyroiditis, with cases exhibiting thyrotoxicosis followed by hypothyroidism, likely mediated by direct viral infiltration or immune dysregulation. Additionally, MPX may contribute to adrenal insufficiency through viral invasion, immune-mediated destruction, or hypothalamic-pituitary-adrenal (HPA) axis dysfunction, exacerbating metabolic and inflammatory complications. MPXV's persistence in testicular tissue raises concerns about reproductive health, with potential implications for fertility, hormone production, and viral transmission. The virus may also modulate host steroid pathways through interactions with glucocorticoid, androgen, and estrogen receptors, influencing immune responses and disease severity. Given these findings, clinicians should maintain vigilance for endocrine dysfunction in MPX patients, particularly in immunocompromised individuals. The role of steroid therapy in MPX remains complex, requiring careful balancing of its anti-inflammatory benefits against potential risks of viral persistence and immune suppression. Further research is essential to clarify MPX's endocrine impact and optimize management strategies.
猴痘（MPX）由猴痘病毒（MPXV）引起，是一种人畜共患的正痘病毒感染，由于持续的人传人传播，其在全球的相关性日益增加。虽然猴痘主要以皮肤和全身受累而闻名，但新出现的证据表明，猴痘也可能扰乱内分泌功能。本叙述性综述旨在综合当前关于猴痘相关内分泌并发症的临床、实验和流行病学研究结果。我们探讨了猴痘病毒对甲状腺、肾上腺和性腺的潜在影响，并讨论了其潜在机制、临床表现以及对患者管理的意义。猴痘与病毒诱导的亚急性甲状腺炎有关，病例表现为甲状腺毒症，随后出现甲状腺功能减退，可能是由病毒直接浸润或免疫失调介导的。此外，猴痘可能通过病毒入侵、免疫介导的破坏或下丘脑-垂体-肾上腺（HPA）轴功能障碍导致肾上腺功能不全，加剧代谢和炎症并发症。猴痘病毒在睾丸组织中的持续存在引发了对生殖健康的担忧，对生育能力、激素产生和病毒传播可能产生影响。该病毒还可能通过与糖皮质激素、雄激素和雌激素受体相互作用来调节宿主类固醇途径，影响免疫反应和疾病严重程度。鉴于这些发现，临床医生应警惕猴痘患者的内分泌功能障碍，尤其是免疫功能低下的个体。类固醇疗法在猴痘中的作用仍然复杂，需要仔细权衡其抗炎益处与病毒持续存在和免疫抑制的潜在风险。进一步的研究对于阐明猴痘对内分泌的影响并优化管理策略至关重要。
