184 CMAAO CORONA FACTS and MYTH
Dr K Aggarwal
With inputs from Dr Monica Vasudev
on Covid-19 IMA-CMAAO Webinar on “COVID-19 and endocrinology”
25th July, 2020, 4-5pm
Dr KK Aggarwal, President CMAAO; Dr RV Asokan, Hony
Secretary General IMA; Dr Ramesh K Datta, Hony Finance Secretary IMA; Dr Avtar
Krishna, Dr S Sharma
Ambrish Mithal, Chairman & Head, Endocrinology and Diabetes,
elective endocrine clinic visits; encourage alternative communication means
such as telehealth.
patients to stay updated with recommended vaccinations.
patients to avoid smoking.
CoV-1 causes long term hypopituitarism, not yet seen in SARS CoV-2.
CoV-2 enters the brain via ACE2 receptor in the olfactory bulb. It cause
anosmia and ageusia and the likely etiology is inflamed sensory epithelium,
although this is not yet proven.
(electrolyte and water imbalance) is a key feature of patients with known
pituitary conditions and Covid-19. Reasons for this include high fever and
tachypnea, diarrhea/vomiting, inability to take adequate fluids (seriously ill
patients). Some amount of hypokalemia is also seen due to upregulation of RAAS
by degradation of ACE2 receptor by the virus.
patients with diabetes insipidus (DI), hyponatremia must be avoided. Allow
excessive urination to start and then give the next dose of desmopressin (in
older patients). Change route of administration (oral pills rather than nasal
desmopressin). In severe Covid, use parenteral desmopressin.
is greater tendency towards hypernatremia and thrombosis in adipsic DI.
patients with hypovolemic shock, restore blood volume with 0.9% saline even if
hypernatremia. If there is no hypovolemic shock, treat with hypotonic fluids.
and accept mild hypernatremia to prevent pulmonary edema.
patients with pre-existing hyperprolactinemia and severe Covid-19, consider
temporary discontinuation of dopamine receptor agonists to prevent additive
vasospasm. Continue DRAs during mild to moderate Covid-19.
initiating treatment in growth hormone deficient patient, who is Covid
positive, call the patient and explain. Do not start on video consultation.
has been demonstrated in adrenal glands, although this has not yet been
reported with SARS-CoV-2.
patients with Covid-19 and pre-existing adrenal insufficiency, doubling of
steroid dose, as suggested by standard guidelines, might be inadequate due to
high levels of acute inflammation. Monitor hospitalised patients for acute
adrenal insufficiency and start on IV/IM hydrocortisone.
has shown association between high serum total cortisol and mortality from
and hypertension in Cushing syndrome have been identified as established poor
prognostic factors in Covid-19. Increased fibrinogen, factor VIII and vWF
together with impaired fibrinolysis in these patients results in prothrombotic
testosterone levels predict adverse outcomes in Covid-19 pneumonia patients. In
a study, total testosterone levels were best in Internal Medicine, while lower
levels were seen in RICU, ICU and deceased patients.
involvement is common in SARS-CoV-2 “orchitis-like syndrome”.
may have a role in Covid-19 severity.
the same regimen of hormone replacement for men and women with hypogonadism until
they can visit the doctor. Temporary discontinuation has no major hazards.
TSH and total T3 is seen in Covid-19. After recovery, there are no differences
in TSH, TT3, TT4, FT3 and FT4. Degree of decrease in TSH and TT3 has a positive
correlation with disease severity.
histopathological study has shown lymphocytic infiltration in the interstitium
in SARS-CoV-2, whereas no inflammatory infiltrate and features of cellular
necrosis in SARS-CoV-1.
thyroiditis has been reported after SARS-CoV-2 infection from Italy.
receptor antibody can obviate the need for a radioiodine or technetium study.
If positive, Graves’s disease; if negative, thyroiditis.
with chronic renal dysfunction and parathyroid dysfunction may be at risk of Covid-19
due to underlying renal disease.
may have an association with Covid-19 severity.
pre-existing parathyroid disorders, elective surgery like parathyroidectomy can
be deferred. Check calcium levels, as HCQ and azithromycin can cause QT
vitamin D deficiency as such patients are more to develop viral acute
respiratory infection. Low dose (1500-2000 units/day), so that patients are at
least not below 10ng.
is no evidence of increased risk of Covid-19 in patients with bone-mineral
patients on IV denosumab, the dose cannot be delayed by more than a couple of
weeks. Switch to oral bisphosphonate (alendronate), if cannot get injection.
is recommended that these drugs should not be started among newly diagnosed
patients during this pandemic.