Endocrine Abstracts

Introduction: There is evidence that SARS-COV-2 infection can result in development of endocrine disturbances. Expression of the angiotensin-converting enzyme 2, which is postulated to be at the center of the pathogenesis of COVID-19, has been reported in various endocrine tissues.

Case Series: We retrospectively analyzed 12 patients with recent history of SARS-COV-2 infection: 5 cases with subacute thyroiditis (SAT), 2 cases with Graves’ disease, 2 cases with adrenal insufficiency, 2 cases with secondary amenorrhea and 1 case with male hypogonadism. Out of 5 patients with SAT, 3 were females and 2 males (34-57 years). SAT developed after a median of 12.8 weeks following COVID-19 infection resolution. The main presenting symptoms were neck pain and palpitations. Thyroid function tests showed overt hyperthyroidism in all patients. Treatment was initiated (4 patients with prednisone, 1 patient with ibuprofen) and within 6 weeks, all patients were asymptomatic, with normalization of inflammatory markers, 3 out of 5 were euthyroid, whereas 2 were hypothyroid. Two female patients were diagnosed with Graves’ disease right after COVID-19 infection (age 31 respectively, 39). Thyroid function tests showed transient hyperthyroidism in the first patient and overt hyperthyroidism in the second patient, with positive thyroid stimulating hormone receptor antibody (TRAb, 3.18 UI/l, respectively >40 UI/l, range 0-1.75). Only the first patient associated Graves’ ophthalmopathy. The second patient had persistent atrial fibrillation and a 4-weeks follow-up showed normal thyroid function under treatment with methimazole. A 20-year-old male presented with chronic fatigue, nausea and vomiting 4 months following COVID-19 infection. He was diagnosed with primary adrenal insufficiency based on elevated ACTH level (1250 pg/ml, range 3-66), low cortisol level (2 μg/dl, range 4.82-19.5) and presence of 21-hydroxilase antibodies. Another 31-year-old female patient presented with orthostatic hypotension 14 months following COVID-19 infection. Laboratory tests revealed elevated ACTH level (195 pg/ml) and suboptimal stimulation after intramuscular 250-μg cosyntropin test. COVID-19 might have contributed to clinically relevant disease progression. Two female patients were diagnosed with secondary amenorrhea after COVID-19 infection (age 28, respectively 35) with good response to progesterone treatment. One male patient was diagnosed with transient hypergonadotrophic hypogonadism following COVID-19 infection. A 2-weeks follow-up showed normalization of serum FSH, LH and testosterone.

Conclusion: The endocrine system is vulnerable to perturbation from SARS-CoV2 infection, therefore among other symptoms and late complications, hormonal parameters should be monitored in these patients. Long-term effects of COVID-19 on the endocrine system remains to be investigated.