“Covid-19 (especially severe disease) has been associated with multiple pre-existing endocrine conditions such as diabetes, obesity, and metabolic syndrome. But there is very limited evidence on new-onset endocrine (hormonal) dysfunction following Covid-19. The study is titled “Spectrum of endocrine dysfunction and association with disease severity in patients with Covid-19: Insights from a cross-sectional, observational study”. This is the only study, to date, with a comprehensive assessment of all hormonal axes in Covid-19, stated Prof. Sanjay Kumar Bhadada, Head, Deptt. of Endocrinology, PGIMER.
Prof. Sanjay Kumar Bhadada further detailed, “Consecutive patients (n=84) admitted at the dedicated Covid care centre at PGIMER were enrolled in the study. Patients were divided into two groups depending on disease severity and comorbidities. 42% had moderate-to-severe disease including those with low oxygen saturation (<94%) i.e hypoxia or chronic comorbidities. The rest 58% had mild disease (no hypoxia or comorbidities). Hypertension (45.7%) and diabetes (33.3%) were the most common comorbidities followed by malignancy, chronic liver or kidney disease, and chronic pulmonary disease.”
The mean age was higher and male gender more common, in patients with moderate-to-severe-disease. They also had higher levels of various inflammatory and disease severity markers (CRP, Ferritin, d-Dimer, LDH). “We evaluated various hormones of the cortisol, thyroid, and gonadal axes. Hormonal parameters were assessed within 24 to 48 hours of admission in a sample in a morning sample and sent under appropriate cold-chain conditions,” added Prof. Bhadada.
Sharing about the inferences, Dr Liza Das, Research Scientist, Dept. of Endocrinology, PGIMER said, “We found that patients with severe Covid-19 had more frequent as well as severe hormonal dysfunction. All patterns of thyroid dysfunction (either secondary hypothyroidism, sick euthyroid syndrome or atypical thyroiditis) were more common in those with severe Covid-19. Though sick euthyroid syndrome does not usually need treatment, both secondary hypothyroidism and thyroiditis need follow-up and timely management. Low cortisol and testosterone were also more common in those with severe Covid-19.”
“The key findings of the Study include Involvement of multiple hormones can be seen in Covid-19; In-hospital low cortisol should be supplemented, but high dose steroids given without supervision and continued indiscriminately may worsen these conditions and these hormonal dysfunctions need to be recognised both during the acute state and on follow-up, for timely management,” concluded Dr Das.