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Associations between Dynamic Vitamin D Level and Thyroid Function during Pregnancy.
Wang, H, Wang, HJ, Jiao, M, Han, N, Xu, J, Bao, H, Liu, Z, Ji, Y
Nutrients. 2022;14(18)
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Thyroid hormones play a vital role in regulating metabolism. Adequate thyroid hormone levels are also critical during pregnancy for optimal fetal growth and development. The foetus is dependent on maternal thyroid hormones until its own thyroid gland matured in the second half of pregnancy. Furthermore, pregnancy impacts thyroid function leading to an increased demand for thyroid hormones. Thyroid disease has been associated with Vitamin D deficiency. During pregnancy, both thyroid disorders and Vitamin D deficiency can have adverse effects on pregnancy and pregnancy outcomes, hence a potential link between Vitamin D status and thyroid function has been postulated. To fill the gaps in previous research, this retrospective cohort study aimed to explore the associations between Vitamin D status and thyroid function throughout the pregnancy, in each trimester. The analysis of hospital data collected in Beijing demonstrated an association between Vitamin D levels and thyroid function throughout pregnancy. Such interlink appeared to be dynamic and changed depending on the stage of pregnancy. The author's findings affirmed that maintenance of adequate Vitamin D levels supports normal thyroid function which is an important nutritional strategy for a healthy pregnancy.
Abstract
Optimal Vitamin D (VitD) status and thyroid function are essential for pregnant women. This study aimed to explore associations between dynamic VitD status and thyroid function parameters in each trimester and throughout the pregnancy period. Information on all 8828 eligible participants was extracted from the Peking University Retrospective Birth Cohort in Tongzhou. Dynamic VitD status was represented as a combination of deficiency/sufficiency in the first and second trimesters. Thyroid function was assessed in three trimesters. The associations between VitD and thyroid function were assessed by multiple linear regression and generalized estimating equation models in each trimester and throughout the pregnancy period, respectively. The results indicated that both free thyroxine (fT4; β = 0.004; 95%CI: 0.003, 0.006; p < 0.001) and free triiodothyronine (fT3; β = 0.009; 95%CI: 0.004, 0.015; p = 0.001) had positive associations with VitD status in the first trimester. A VitD status that was sufficient in the first trimester and deficient in the second trimester had a lower TSH (β = -0.370; 95%CI: -0.710, -0.031; p = 0.033) compared with the group with sufficient VitD for both first and second trimesters. In conclusion, the associations between VitD and thyroid parameters existed throughout the pregnancy. Maintaining an adequate concentration of VitD is critical to support optimal thyroid function during pregnancy.
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Systematic review and meta-analysis of candidate gene association studies of benign prostate hyperplasia.
Lin, L, Li, P, Liu, X, Xie, X, Liu, L, Singh, AK, Singh, HN
Systematic reviews. 2022;11(1):60
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Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate which can cause urinary dysfunction and may affect the quality of life of patients. Polymorphism in several genes has been linked to the high susceptibility of BPH. The aim of this study was to analyse genetic variations in important genes towards the susceptibility of BPH. This study is a systematic review and meta-analysis of twenty-three case-control studies (11 for CYP17 [gene], 10 for VDR - vitamin D receptor [a member of the steroid/ thyroid hormone receptor family] and 4 for ACE - angiotensin-converting enzyme [component of the renin–angiotensin system] polymorphisms). The sample size in each study ranged from 20 to 588 participants. Results show that genetic polymorphism in the ACE gene was significantly associated with the risk of BPH when compared with control subjects. Whereas there was a negative association for the polymorphism located in VDR and CYP17 genes with the risk of BPH. Authors conclude that larger studies with prospective data and larger sample sizes are required.
Abstract
BACKGROUND Benign prostate hyperplasia (BPH) is the most common urological problem in elderly males. Recent studies have reported polymorphism in various metabolic genes in BPH. However, their association with the susceptibility of BPH is still inconsistent. Here, we systematically reviewed and performed a meta-analysis of CYP17, VDR, and ACE genes to determine their precise association with the risk of BPH. METHODS A comprehensive literature search for published studies on candidate gene associations involving vitamin D receptor (VDR), angiotensin-converting enzyme (ACE), and CYP17 genes with the risk of BPH was done up to April 2020 in PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases. Fixed/random effects models were used to estimate the odd's ratio (OR) and 95% confidence intervals (CIs). Begg's funnel plot was used to assess the potential for publication bias. RESULTS We found a total of 23 studies containing 3461 cases and 3833 controls for these gene polymorphisms. A significant association of ACE gene polymorphism was observed under the recessive (II vs. ID + DD) model for BPH susceptibility compared to control subjects (overall OR = 1.67, 95% CI = 1.03-2.73). Similar trends were observed for ACE gene polymorphism in Caucasian (OR = 6.18, 95% CI = 1.38-27.68) and Asian (OR = 1.42, 95% CI = 0.99-2.03) populations under study. No significant association was observed in VDR and CYP17 gene polymorphisms in any dominant or recessive models. CONCLUSION Significant OR demonstrated the implication of ACE gene polymorphism in the proliferation of prostate tissue, which in turn is associated with BPH susceptibility. However, prospective studies at large scale and sample size are needed to confirm the current findings.
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Vitamin D and miscarriage: a systematic review and meta-analysis.
Tamblyn, JA, Pilarski, NSP, Markland, AD, Marson, EJ, Devall, A, Hewison, M, Morris, RK, Coomarasamy, A
Fertility and sterility. 2022;118(1):111-122
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Miscarriage causes significant physical and psychological harm. Vitamin D deficiency (low serum levels of 25- hydroxyvitamin D) is a major global health concern, with pregnant women and those planning pregnancy at increased risk. The aim of this study was to evaluate the association between vitamin D status and pregnancy loss, including spontaneous miscarriage and recurrent miscarriage. This study is a systematic review and meta-analysis of ten studies (6 where observational studies and 4 interventional studies). Results show that women who were vitamin D deficient were at significantly increased risk of miscarriage compared with those who were vitamin D replete. This association was maintained when women with insufficient levels were included, with a biologic gradient evident. Authors conclude that new evidence-based interventions are required for women at risk of miscarriage.
Abstract
OBJECTIVE To investigate whether a significant association between vitamin D status and the risk of miscarriage or recurrent miscarriage (RM) exists. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S): Women with miscarriage and RM. INTERVENTION(S): We searched the Ovid MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials from database inception to May 2021. Randomized and observational studies investigating the association between maternal vitamin D status and miscarriage and/or vitamin D treatment and miscarriage were included. MAIN OUTCOME MEASURE(S): The primary outcome was miscarriage or RM, with vitamin D status used as the predictor of risk. Whether vitamin D treatment reduces the risk of miscarriage and RM was also assessed. RESULT(S): Of 902 studies identified, 10 (n = 7,663 women) were included: 4 randomized controlled trials (n = 666 women) and 6 observational studies (n = 6,997 women). Women diagnosed with vitamin D deficiency (<50 nmol/L) had an increased risk of miscarriage compared with women who were vitamin D replete (>75 nmol/L) (odds ratio, 1.94; 95% confidence interval, 1.25-3.02; 4 studies; n = 3,674; I2 = 18%). Combined analysis, including women who were vitamin D insufficient (50-75 nmol/L) and deficient (<50 nmol/L) compared with women who were replete (>75 nmol/L), found an association with miscarriage (odds ratio, 1.60; 95% confidence interval, 1.11-2.30; 6 studies; n = 6,338; I2 = 35%). Although 4 randomized controlled trials assessed the effect of vitamin D treatment on miscarriage, study heterogeneity, data quality, and reporting bias precluded direct comparison and meta-analysis. The overall study quality was "low" or "very low" using the Grading of Recommendations, Assessment, Development and Evaluations approach. CONCLUSION(S): Vitamin D deficiency and insufficiency are associated with miscarriage. Whether preconception treatment of vitamin D deficiency protects against pregnancy loss in women at risk of miscarriage remains unknown. REGISTRATION NUMBER CRD42021259899.
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Effects of vitamin D treatment on thyroid function and autoimmunity markers in patients with Hashimoto's thyroiditis-A meta-analysis of randomized controlled trials.
Jiang, H, Chen, X, Qian, X, Shao, S
Journal of clinical pharmacy and therapeutics. 2022;47(6):767-775
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Hashimoto's thyroiditis (HT), also called chronic lymphocytic thyroiditis, is the most prevalent organ-specific autoimmune disorder as well as the most common cause of thyroid hypofunction. The main purpose of HT treatment is the control of hypothyroidism, including oral administration of a synthetic hormone to achieve normal circulating thyrotropin levels. The aim of this study was to review the association between vitamin D treatment in patients with HT by assessing patients’ serum circulating 25-hydroxyvitamin D - 25(OH)D - level to evaluate whether a change occurs in the course of disease. This study is a systematic review and meta-analysis of seven cohorts of patients from six studies (3 prospective cohort studies and 3 randomised controlled trials). Results show that vitamin D might significantly increase the serum 25(OH)D levels and produce changes in thyroid peroxidase antibodies titres. However, there wasn't a significant association between serum vitamin D supplementation and the levels of thyroid-stimulating hormone, thyroglobulin antibodies, free triiodothyronine and free thyroxine. Authors conclude that their findings suggest that vitamin D is not associated with the function of the thyroid in patients with HT. Thus, further well-designed randomised controlled trials with sufficient sample sizes investigating the effect of vitamin D on thyroid function are still warranted.
Abstract
INTRODUCTION Recent evidence suggested that vitamin D deficiency was associated with Hashimoto's thyroiditis (HT) pathogenesis and thyroid hypofunction. This study aimed to investigate whether vitamin D supplementation would be effective in the prevention and progression of hypothyroidism in patients with HT. METHODS PubMed, Embase and the Cochrane library were searched for randomized controlled trials (RCTs) and prospective cohort studies published from inception to August 2021. RESULTS A total of 7 cohorts of patients from six clinical trials with 258 patients with HT were included. Significant difference was found (WMD = 19.00, 95% CI: 12.43, 25.58, p < 0.001; I2 = 90.0%, pheterogeneity < 0.001) between the vitamin D group and control group in serum 25-hydroxyvitamin D level. And the combined results indicated vitamin D supplementation significantly reduced the level of thyroid peroxidase antibodies (TPO-Ab) compared to the control group (WMD = -158.18, 95% CI: -301.92, -14.45, p = 0.031; I2 = 68.8%, pheterogeneity = 0.007). Whereas no significant differences were found on the levels of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4) compared to the control group (p > 0.05). WHAT IS NEW AND CONCLUSION Our study demonstrated that vitamin D treatment might significantly increase the serum 25(OH)D levels and produce changes in TPO-Ab titres. No significant association was found between serum vitamin D treatment and the levels of TG-Ab, TSH, FT3 and FT4, suggesting that vitamin D is not associated with the function of the thyroid in patients with HT.
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Associations between Diet Quality and Anthropometric Measures in White Postmenopausal Women.
Arikawa, AY, Kurzer, MS
Nutrients. 2021;13(6)
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Menopause is associated with hormonal fluctuations, which may cause biological and behavioural changes such as sleep disturbances, obesity, and bone loss. Dietary modifications may reduce the impact of weight gain and bone loss. The aim of this cross-sectional study was to determine the association between diet quality and body measurements in 937 post-menopausal women. The results showed that the average waist circumference was 83cm, which is associated with an increased risk of developing chronic diseases. A healthier diet was associated with lower waist circumference. Intakes of whole grains, dairy, protein, sodium, and saturated fat were not at recommended levels. Only 12.5% consumed the recommended daily intake of calcium and even in those taking calcium supplements, intakes were still inadequate. There were no associations between bone mass density and calcium or vitamin D intake, however there was a trend towards increased bone density with physical activity. It was concluded that a healthier diet was associated with a lower occurrence of obesity. Although no associations between calcium intake and BMD were seen, further studies are warranted. Healthcare professionals could use this study to understand the importance of recommending a healthier diet in postmenopausal women to prevent obesity and chronic diseases.
Abstract
The purpose of this cross-sectional study was to examine the relationship between diet and anthropometric measures in postmenopausal women. Data collected from 937 women enrolled in the Minnesota Green Tea Trial (NTC00917735) were used for this analysis. Dietary intake and health-related data were collected via questionnaires. Body weight, height, and waist circumference (WC) were measured by the study staff. The mean age of participants was 59.8 years and mean WC was 83 cm. Approximately 30% of the participants had WC greater than 88 cm. Healthy Eating Index-2015 score was 72.6 and the Dietary Inflammatory Index score was 0. Intakes of whole grains, dairy, protein, sodium, and saturated fat did not meet the dietary guidelines. Only 12.5% consumed the recommended daily amount of calcium (mean intake = 765 mg/day). When calcium supplements were considered, only 35.2% of the participants had adequate intakes, even though 68.9% reported taking a calcium supplement. We found that age and number of medications taken were significantly associated with waist circumference (p = 0.005). Women who reported taking two or more medications had greater WC (85 cm) compared to women who reported not taking any medications (82.2 cm), p = 0.002. Our findings suggest that achieving adequate calcium and vitamin D intake may be challenging to postmenopausal women.
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Vitamin D Boosts Alendronate Tail Effect on Bone Mineral Density in Postmenopausal Women with Osteoporosis.
Catalano, A, Bellone, F, Santoro, D, Schwarz, P, Gaudio, A, Basile, G, Sottile, MC, Stoian, SA, Corica, F, Morabito, N
Nutrients. 2021;13(6)
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Post-menopausal women are at an increased risk for bone associated disorders such as osteoporosis. Treatments with drugs known as bisphosphonates aim to increase bone density, bone strength, and reduce bone fractures. However long-term treatment may be associated with poor outcomes and short treatment breaks where use is discontinued, may be of benefit. Vitamin D, which has shown to be of benefit during treatment with bisphosphonates, may be of increased importance during these treatment breaks. This retrospective study of postmenopausal women aimed to determine if vitamin D status influenced bone density after osteoporosis treatment had ceased in 1686 patients. The results showed that in those who discontinued osteoporosis treatment, individuals with the highest levels of vitamin D had a greater increase in bone mineral density. Bone density was also associated with a change in vitamin D level. It was concluded that in those who have discontinued osteoporosis treatment improving vitamin D status may be of benefit to bone density. This study could be used by healthcare professionals to understand how vitamin D supplementation may be of benefit in osteoporotic, post-menopausal women who have stopped treatment due to worries of long-term side effects.
Abstract
Vitamin D modulates bisphosphonate (BP) efficacy, but its contribution to bone mineral density (BMD) after BP discontinuation is not known. To address this topic, we performed a retrospective analysis of postmenopausal women exposed to alendronate (ALN) to treat osteoporosis who regularly continued the supplementation of cholecalciferol or calcifediol at recommended doses. In the ninety-six recruited women (age 61.1 ± 6.9 years), ALN was administered for 31.2 ± 20.6 months and then discontinued for 33.3 ± 18.9 months. The modification of 25(OH)D serum levels over time was associated with a change of alkaline phosphatase (r = -0.22, p = 0.018) and C-terminal collagen type 1 telopeptide (r = -0.3, p = 0.06). Women in the tertile of the highest increase in 25(OH)D level showed a 5.7% BMD gain at lumbar spine, that was twice as great in comparison with participants with a lower 25(OH)D variation. At a multiple regression analysis, BMD change was associated with time since menopause (ß = 2.28, SE 0.44, p < 0.0001), FRAX score for major fracture (ß = -0.65, SE 0.29, p = 0.03), drug holiday duration (ß = -2.17, SE 0.27, p < 0.0001) and change of 25(OH)D levels (ß = 0.15, SE 0.03, p = 0.0007). After ALN discontinuation, improving the vitamin D status boosts the ALN tail effect on BMD.
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Manipulation of Dietary Intake on Changes in Circulating Testosterone Concentrations.
Zamir, A, Ben-Zeev, T, Hoffman, JR
Nutrients. 2021;13(10)
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Androgens, like testosterone, are steroid hormones commonly associated with reproduction. However, they also govern metabolic functions, body composition and growth. Higher levels of circulating androgens enhance athletic performance by supporting metabolic activities such as protein production, regeneration and growth and by inhibiting breakdown processes. Manipulating testosterone to enhance athletic performance without the use of anabolic steroids hormones has been of much interest. As macro-and micronutrients can influence androgen hormones, this review examined whether specific energy and nutrient intake can ‘naturally’ manipulate testosterone levels. The authors describe the metabolic functions of testosterone before exploring the current evidence on selected plant extracts and nutrients and their impact on aromatase activity. Inhibiting aromatase can prevent androgens from being converted into oestrogen and thus may help to raise circulating androgens. Discussed are a range of plant-derived compounds, flavonoids, macronutrients and micronutrients (Vitamin D, Zinc and Magnesium) and their impact on testosterone levels. The authors conclude that the nutrients discussed have some supportive evidence, yet overall findings are inconclusive due to limited studies. Regarding macronutrients more research is available, and the evidence supports that low energy intake negatively impacts testosterone levels and performance. Whereby supplementation of vitamins crucial to testosterone production seems to provide value in cases of deficiency further research is required. This article yields an overview of plant compounds, macro-and micronutrients and their potential impact on circulating testosterone levels. While low energy intake and nutrient deficiencies appears to be unfavourable, the absence of clear evidence on other compounds would warrant further case-specific investigations.
Abstract
Elevations in the circulating concentration of androgens are thought to have a positive effect on the anabolic processes leading to improved athletic performance. Anabolic-androgenic steroids have often been used by competitive athletes to augment this effect. Although there has been concerted effort on examining how manipulating training variables (e.g., intensity and volume of training) can influence the androgen response to exercise, there has been much less effort directed at understanding how changes in both macronutrient and micronutrient intake can impact the androgen response. Thus, the focus of this review is to examine the effect that manipulating energy and nutrient intake has on circulating concentrations of testosterone and what the potential mechanism is governing these changes.
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Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function?
Knezevic, J, Starchl, C, Tmava Berisha, A, Amrein, K
Nutrients. 2020;12(6)
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Thyroid and gut disease often coexist together. This literature review highlights the strong interplay between gut, microbiota and thyroid disease. In autoimmune thyroid disease (AITD) gut bacteria imbalances, bacterial overgrowth, Coeliac's disease or non-coeliacs wheat sensitivity, increased gut permeability and resulting deficiency of thyroid nutrients are not uncommon. Inflammation and intestinal wall damage that lead to increased permeability are thought to be one of the driving factors for autoimmune activity. Allergens, certain drugs, impaired gut flora and nutrient deficiencies are some of the contributors to heightened intestinal permeability. Furthermore, the gut walls host deiodinase enzymes that convert thyroid hormone to its active form. The gut microbiota however influence thyroid function in their own rights. The bacteria are crucial for nutrient synthesis, absorption and availability, including those essential for thyroid health. Gut bacteria and their metabolites also play a significant role in the regulation, development and training of immune cells, relevant to AITD. After all, the gut also houses a large proportion of the immune system known as gut-associated lymphatic tissue (GALT). Besides, some bacteria species seem to be capable of balancing fluctuating thyroid hormone levels in the blood. The writings further elaborate on thyroid-essential nutrients and the gut such as iodine, iron, zinc, selenium and Vitamin D. And the impact of bariatric surgery on thyroid function and the presence of certain gut bacteria in thyroid cancers. In summary, the authors concluded that the thyroid-gut axis seems to exhibit a strong connection. Limited evidence from human studies showed promising results of probiotics and synbiotics on thyroid function and targeting the microbiota as a novel strategies for the management of thyroid disease is encouraged to be explored further. This article may be of interest to those looking for an informative summary on the many ways in which the gut influences thyroid function in health and disease.
Abstract
A healthy gut microbiota not only has beneficial effects on the activity of the immune system, but also on thyroid function. Thyroid and intestinal diseases prevalently coexist-Hashimoto's thyroiditis (HT) and Graves' disease (GD) are the most common autoimmune thyroid diseases (AITD) and often co-occur with Celiac Disease (CD) and Non-celiac wheat sensitivity (NCWS). This can be explained by the damaged intestinal barrier and the following increase of intestinal permeability, allowing antigens to pass more easily and activate the immune system or cross-react with extraintestinal tissues, respectively. Dysbiosis has not only been found in AITDs, but has also been reported in thyroid carcinoma, in which an increased number of carcinogenic and inflammatory bacterial strains were observed. Additionally, the composition of the gut microbiota has an influence on the availability of essential micronutrients for the thyroid gland. Iodine, iron, and copper are crucial for thyroid hormone synthesis, selenium and zinc are needed for converting T4 to T3, and vitamin D assists in regulating the immune response. Those micronutrients are often found to be deficient in AITDs, resulting in malfunctioning of the thyroid. Bariatric surgery can lead to an inadequate absorption of these nutrients and further implicates changes in thyroid stimulating hormone (TSH) and T3 levels. Supplementation of probiotics showed beneficial effects on thyroid hormones and thyroid function in general. A literature research was performed to examine the interplay between gut microbiota and thyroid disorders that should be considered when treating patients suffering from thyroid diseases. Multifactorial therapeutic and preventive management strategies could be established and more specifically adjusted to patients, depending on their gut bacteria composition. Future well-powered human studies are warranted to evaluate the impact of alterations in gut microbiota on thyroid function and diseases.
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COVID-19 and diabetes: The why, the what and the how.
Cuschieri, S, Grech, S
Journal of diabetes and its complications. 2020;34(9):107637
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Early reports have shown that individuals with diabetes who contract Covid-19 have higher hospital admissions and mortality rates, classing them as a vulnerable group. This review paper aimed to explain why this group of people are vulnerable and what measures could be recommended. The paper outlined that individuals with diabetes have a compromised immune system due to uncontrolled blood sugar levels. In addition to this, individuals with diabetes and Covid-19 may have a higher risk of organ damage due to the effects of the body's immune response combined with the disordered biological processes associated with their pre-existing condition. Conversely, it was discussed that Covid-19 could exacerbate diabetes progression if the Covid-19 virus entered the cells of the pancreas, causing a blood sugar imbalance. As a result, the importance of optimal blood sugar control was outlined. Several medications were addressed and their benefits/disadvantages discussed. Amongst those reviewed were medications such as GLP-1 agonists, which may help with controlling blood sugar levels and may prevent Covid-19 entering the body's own cells, and metformin, which was initially developed as an anti-influenza drug. Finally the paper discussed diabetes specific precautions to avoid contracting Covid-19. Vitamin D supplementation, regular blood sugar checks, lifestyle measures such as exercise and dietary requirements and allowing individuals with diabetes to have large supplies of their medications to avoid leaving the house were discussed. It was concluded that during the Covid-19 pandemic, individuals with diabetes require particular care in order to avoid additional burden on healthcare systems. For those individuals with diabetes who haven’t contracted Covid-19, this paper could be used to recommend any extra precautions to take to avoid contracting this virus.
Abstract
BACKGROUND The novel coronavirus SARS-CoV-2 has taken the world by storm. Alongside COVID-19, diabetes is a long-standing global epidemic. The diabetes population has been reported to suffer adverse outcomes if infected by COVID-19. The aim was to summarise information and resources available on diabetes and COVID-19, highlighting special measures that individuals with diabetes need to follow. METHODS A search using keywords "COVID-19" and "Diabetes" was performed using different sources, including PubMed and World Health Organization. RESULTS COVID-19 may enhance complications in individuals with diabetes through an imbalance in angiotension-converting enzyme 2 (ACE2) activation pathways leading to an inflammatory response. ACE2 imbalance in the pancreas causes acute β-cell dysfunction and a resultant hyperglycemic state. These individuals may be prone to worsened COVID-19 complications including vasculopathy, coagulopathy as well as psychological stress. Apart from general preventive measures, remaining hydrated, monitoring blood glucose regularly and monitoring ketone bodies in urine if on insulin is essential. All this while concurrently maintaining physical activity and a healthy diet. Different supporting entities are being set up to help this population. CONCLUSION COVID-19 is a top priority. It is important to remember that a substantial proportion of the world's population is affected by other co-morbidities such as diabetes. These require special attention during this pandemic to avoid adding on to the burden of countries' healthcare systems.
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Endocrine and metabolic aspects of the COVID-19 pandemic.
Marazuela, M, Giustina, A, Puig-Domingo, M
Reviews in endocrine & metabolic disorders. 2020;21(4):495-507
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Endocrine and metabolic related diseases such as diabetes and obesity may increase the risk of developing severe Covid-19 and as a result these diseases could be severely affected by Covid-19 infection. This very large review paper looked at over 100 studies and outlined the interrelationship between Covid-19 infection and several endocrine diseases. Diabetes, obesity, pituitary-hypothalamic function, thyroid function, Cushing's syndrome and adrenal function were all reviewed. No aim was stated. Data on individuals with obesity and diabetes indicated an increased risk for severe Covid-19 infection, hospitalisation and mortality. Data surrounding pituitary-hypothalamic function, thyroid function, Cushing's syndrome and adrenal function was less abundant, however neurological issues in Covid-19 patients suggested an involvement of the pituitary and hypothalamus. In lieu of sufficient data the author commented on the possible similarities between severe acute respiratory syndrome coronavirus with the Covid-19 virus. A number of management strategies were discussed such as the use of vitamin D, oxytocin and melatonin, however the authors commented on the lack of data regarding oxytocin and melatonin in Covid-19 patients, but mechanistic data suggested they might be of use. No overall conclusions were drawn on the findings. Clinicians could use this paper to understand how patients with pre-existing endocrine and metabolic conditions may be at a higher risk of more severe Covid-19 and if contracted could exacerbate their pre-existing condition. These patients could require constant monitoring and additional measures to avoid contracting Covid-19. Supplements such as vitamin D, oxytocin or melatonin could be therapeutic, however more data needs to be reviewed.
Abstract
COVID-19 infection has tremendously impacted our daily clinical practice as well as our social living organization. Virtually all organs and biological systems suffer from this new coronavirus infection, either because the virus targets directly specific tissues or because of indirect effects. Endocrine diseases are not an exception and some of endocrine organs are at risk of direct or indirect lesion by COVID-19. Although there is still no evidence of higher predisposition to contract the infection in patients with diabetes and/or obesity, the coexistence of these conditions contributes to a worse prognosis because both conditions confer an impaired immunologic system. Cytokines storm can be amplified by these two latter conditions thereby leading to multisystemic failure and death. Glycaemic control has been demonstrated to be crucial to avoiding long hospital stays, ICU requirement and also prevention of excessive mortality. Endocrine treatment modifications as a consequence of COVID-19 infection are required in a proactive manner, in order to avoid decompensation and eventual hospital admission. This is the case of diabetes and adrenal insufficiency in which prompt increase of insulin dosage and substitutive adrenal steroids through adoption of the sick day's rules should be warranted, as well as easy contact with the health care provider through telematic different modalities. New possible endocrinological targets of COVID-19 have been recently described and warrant a full study in the next future.