Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2022 | Month : February | Volume : 16 | Issue : 2 | Page : OE01 - OE03 Full Version

Association of COVID-19 and Endocrine Disorders


Published: February 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/50986.15927
Deep Hathi, Sourya Acharya, Samarth Shukla, Vidyashree S Hulkoti

1. Resident, Department of Medicine, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 2. Professor and Head, Department of Medicine, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 3. Professor, Department of Pathology, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 4. Resident, Department of Medicine, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.

Correspondence Address :
Dr. Vidyashree S Hulkoti,
Resident, Department of Medicine, 3rd Floor, Acharya Vinoba Bhave Hospital,
Wardha-442001, Maharashtra, India.
E-mail: drvidyahulkoti@gmail.com

Abstract

Coronavirus Disease 2019 (COVID-19), caused by the coronavirus, since its start in Wuhan a city in China has spread like a wild fire and created havoc all over the globe. Initially, the disease was thought to be causing only respiratory complications, but gradually it was found to be causing multiorgan complications. Due to the hypercoagulable property of coronavirus, it has shown neurological, cardiological and endocrine complications. Recently, the effect of the virus on endocrine system has also been noted. Evidence has shown that COVID-19 can hamper the hypothalamo-pituitary axis resulting in altered adrenal response to stress. The immune-mediated damage to the endocrine glands results in subacute thyroiditis. The presence of Angiotensin Converting Enzyme 2 (ACE 2) receptors on various tissues could be the cause of this immune mediated damage. The COVID-19 has also precipitated hyperglycaemia and in few cases, uncovered the insulin resistance in previously undiagnosed cases. It is crucial to have knowledge about the impact of endocrine system, as it is the powerhouse of the body.

Keywords

Angiotensin converting enzyme 2 receptors, Coronavirus disease 2019, Cytokine storm, Endocrine system, Hypothalamo-pituitary axis

Severe Acute Respiratory Syndrome–Coronavirus-2 (SARS-CoV -2), A novel Coronavirus (nCoV), that resulted in the recent outbreak of COVID-19, was first discovered in province of Wuhan of China in December 2019 (1). COVID-19 which in the initial few days is asymptomatic can gradually deteriorate in few days complicated by pneumonia and Acute Respiratory Distress Syndrome (ARDS) (2). The pathogenesis of COVID-19 has been related to entry of virus via the respiratory tract and its interaction with ACE 2 receptors that leads to entry into host pneumocytes. Moreover, the Ribonucleic Acid (RNA) of COVID-19 virus has been detected in the sera of patients thus implying free interaction of virus with any tissue containing ACE 2 receptors (3). Various endocrine organs like pancreas, thyroid, adrenals, pituitary and gonads express ACE 2 receptors, thus, opening up the possibility of their involvement during the course of disease (2). The present article aimed to provide a narrative review of the involvement of endocrine system with COVID-19.

COVID-19 and Thyroid Gland

The nCoV causes “cytokine storm” which is linked to immune response hyperactivity involving Th1/Th17 lymphocytes resulting in release of various pro-inflammatory cytokines like Tumour Necrosis Factor-Alpha (TNF?) and Interleukin-6 (IL-6) (4). This may lead to thyrotoxicosis, disruption of de-iodinases and thyroid hormone transport proteins, and impaired pituitary Thyroid Stimulating Hormone (TSH) secretion. Another unique thyroid gland dysfunction is known as ‘low Triiodothyronine (T3) syndrome’ or ‘sick euthyroid syndrome’ which is characterised by low T3 levels, normal to moderately decreased Tetraiodothyronine (T4) levels and normal to low TSH. These thyroid gland abnormalities are transient and do not require any treatment (5).

Autopsies done in patients with SARS-CoV-2 infection have shown destruction of thyroid follicular cells. Histological examination of thyroid gland has revealed absence of lymphocytic infiltrate but presence of apoptosis suggestive of thyroiditis (6). A recent study done on patients with COVID-19 pneumonia showed low levels of T3 and TSH as compared to non COVID-19 pneumonia. A significant association was found between low T3 and severe form of COVID-19 resulting in more death than SARS-CoV-2 survivors (7). In another follow-up study done by Muller I et al., on eight patients having findings of atypical subacute thyroiditis, two developed hypothyroidism while six had suppressed TSH suggesting long term effects of SARS-CoV-2 on thyroid gland (8).

COVID-19 and Pancreas

The ACE 2 receptors are also present in the pancreas with m-RNA levels being higher in the pancreas than in lungs. This expression involves both the exocrine and endocrine functions of pancreas (9). Hyperglycaemia has been frequently reported in COVID-19 (10). A recent study which explored physiological model for SARS-CoV-2 using organoid derivatives from human pluripotent stem cells, demonstrated alpha and beta-cell death due to viral cytotoxic effects. Islet cell injury by SARS-CoV-2 may result in hyperglycaemia and acute diabetes (11). Immunohistochemistry and in-situ hybridisation done on pancreas of patients who died due to COVID-19 showed evidence of SARS-CoV-2 (12). Worsening of insulin resistance has been reported in patients with pre-existing diabetes with SARS-CoV-2. Increased levels of glycoprotein called serum fetuin has been reported in SARS-CoV-2 which is associated with impaired insulin sensitivity (13). Anti-retroviral drugs like Lopinavir–ritonavir which has been suggested as possible treatment for COVID-19 can lead to lipodystrophy and subsequent development of insulin resistance (14).

Treatment with chloroquine/hydroxylchloroquine can lead to hypoglycaemia, especially, if the patient is on insulin or sulfonylureas with possible mechanisms being interaction with insulin release, degradation and action (15). Diabetic patients with COVID-19 are at increased risk of developing severe pneumonia, ARDS and mortality as compared to non diabetics; with possible explanation in such patients being suppressed immunity and down-regulation of ACE 2 levels (16). Recent survey done in United Kingdom (UK) on 23,804 patients who died due to COVID-19 showed that about 32% had type 2 Diabetes Mellitus (DM) while 1.5% had type 1 DM with odds ratio of 2.03 and 3.5 respectively of dying from large number of
COVID-19 patients have been reported to develop diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome during the course of illness. In one study, ketosis was reported in 6.4% in COVID-19 patients, with incidence rising to 11.6% in patients with diabetes and was associated with higher mortality rate (33%) (17),(18).

Obese patients are more likely to develop severe pneumonia and ARDS and are more likely to die from COVID-19 as compared to non obese individuals (19). Adipose tissue also expresses ACE 2 receptor and obese persons have higher adipose tissue, leading to increased ACE 2 receptors for binding of SARS-CoV-2 (20). Various mechanisms have been proposed for higher mortality in obese individuals. Obesity often co-exists with diabetes and both are pro-inflammatory states leading to increase levels of pro-inflammatory markers like leptin and decreased levels of anti-inflammatory markers like adiponectin (17). Also, obesity is associated with lower vitamin D levels, which might impair the immune response (21). In a study, the requirement of invasive mechanical ventilation in individuals admitted in Invasive Care Unit (ICU) with Body Mass Index (BMI) more than 35 kg/m2 was seven times more than persons with BMI of less than 25 kg/m2 (22). Another study concluded that individuals with BMI more than 25 kg/m2 and non alcoholic fatty liver disease were six times more likely to develop severe infection as compared to non obese individuals (23). It has been hypothesised that the vaccines that are being developed to control the COVID-19 pandemic, will be less effective in obese individuals due to poor immune response due to altered immunity pathway (24).

COVID-19 and Adrenal Gland

The ACE 2 receptor is also expressed in adrenal glands. In a study done by Freire Santana M et al., autopsy findings of adrenal glands of 28 patients who died of severe COVID-19 infection, microscopic lesions were identified in the adrenal glands in 13/28 patients (46%) (25). Seven cases showed necrosis, generally ischaemic; four showed cortical lipid degeneration; two showed haemorrhage; and one unspecific focal adrenalitis (25).

The primary mechanism adopted by SARS-CoV virus is to blunt the host cortisol stress response. A very interesting mechanism has been proposed to explain this finding- “molecular mimicry” i.e., sharing of certain amino acid sequence by SARS-CoV with the host Adrenocorticotropic Hormone (ACTH) sequence (26). Since proteins of SARS-CoV-2 share similarity (95-100%) with original SARS-CoV, similar mechanism of molecular mimicry has been proposed for blunted adrenal response (2). The benefits of glucocorticoid therapy in COVID-19 could be because of propensity of SARS-CoV-2 to cause impaired host stress cortisol response and subsequent adrenal insufficiency. Another mechanism of benefit could be the tackling of the phenomenon of ‘cytokine storm’ by reducing inflammation (27).

Early studies failed to show benefit of glucocorticoid therapy in reducing mortality and was instead associated with increased hospital stay and delayed viral clearing (27). On the basis of these studies, World Health Organisation (WHO) recommended against the use of glucocorticoids in COVID-19 except in refractory shock (28). However, the ‘RECOVERY’ trial was a landmark study which showed that use of dexamethasone is associated with 17% reduction in mortality of ill-ventilated ventilated patients (29). Accordingly, dexamethasone has been recommended for use in moderate and severe COVID-19 patients. In a recent study by Tan T et al., patients with severe COVID-19 infections were found to have blunted adrenal response and baseline serum cortisol level was a reliable indicator of mortality in COVID-19 (30).

COVID-19 and Pituitary Gland

Leow MK-S et al., first reported disruption of pituitary gland function during SARS-CoV-2 outbreak. A total of 61 patients were followed up at three months after recovery, of which 40% had mild central hypocortisolism. Among this 62.5% resolved within a year, while 5% developed central hypothyroidism. Autopsy findings showed evidence of oedema and neuronal degeneration of hypothalamus along with SARS-CoV genome. The authors had proposed the possibility of reversible hypophysitis or direct involvement of hypothalamus leading to disruption of hypothalamic-pituitary axis (31). ACE 2 receptors are involved in the SARS- CoV-2 infection. These same, ACE 2 receptors are present in hypothalamus and pituitary gland which leads to its affect in COVID-19 infection. However, at present ample data of pituitary involvement in COVID-19 is not available. It is thought that due to higher incidence of neurological symptoms in SARS-CoV-2, involvement of hypothalamus and pituitary gland can occur either directly or due to immune mediated hypophysitis. Thus, an eagles eye should be kept on hypothyroidism in cases with unexplained symptoms like fatigue, lassitude, malaise, orthostatic dizziness, anorexia and apathy (2).

COVID-19 and Lipid Profile

Four cases of hypertriglyceridemia have been reported till date, possibly, as a side effect of drugs used in the treatment of COVID-19. Two cases were due to use of combination of lopinavir/ritonavir (32) while remaining two were due to simultaneous use of the above combination along with tocilizumab (33).

Due to immunomodulatory actions, statins have been proposed as a possible add-on drug therapy in patients with COVID-19 (34). Statins exert pleiotropic effects on inflammation and oxidative stress and modulate the immune response at different levels, including immune cell adhesion and migration, antigen presentation, and cytokine production (34). Studies in the past have reported efficiency of statins in treatment of various influenza virus by reducing hospital stay and mortality (35). Moreover, statins are economical, extensively studied and widely available and can be explored as a possible adjunctive treatment option.

COVID-19 and Andrgens

Males are more prone to develop infection on exposure to the virus and have higher mortality than females (36). The viral entry requires two host proteins- ACE 2 receptor and transmembrane protease, serine 2 (TMPRSS2). Transcription of TMPRSS2 requires androgen receptor activity. This modulation of TMPRSS2 by testosterone has been considered as major reason for male predominance of worse outcomes. Since, TMPPRSS2 is expressed in lungs and its inhibitor has been widely used in treatment of prostate cancer, it can emerge as a target specific treatment for prevention or treatment of COVID-19 pneumonia (37).

Conclusion

There appears to be widespread involvement of endocrine organs in patient with COVID-19. Considering the ongoing COVID-19 pandemic, future prospective studies are needed to increase epidemiological and clinical knowledge and optimise the management of endocrine disorders in COVID-19 patients.

References

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Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel corona virus to global health- The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264-66. [crossref] [PubMed]
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Muller I, Cannavaro D, Dazzi D, Covelli D, Mantovani G, Muscatello A, et al. SARS-CoV-2-related atypical thyroiditis. Lancet Diabetes Endocrinol. 2020;8(9):739-41. [crossref]
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DOI and Others

DOI: 10.7860/JCDR/2022/50986.15927

Date of Submission: Jun 22, 2021
Date of Peer Review: Jul 30, 2021
Date of Acceptance: Sep 29, 2021
Date of Publishing: Feb 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 24, 2021
• Manual Googling: Sep 27, 2021
• iThenticate Software: Nov 09, 2021 (21%)

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