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Steroids May Offer COVID-19 Treatment Strategy in Patients With Endocrine Disorders

People with endocrine disorders may see their condition worsen as a result of COVID-19, according to a new review published in the Journal of the Endocrine Society.

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We explored the previous SARS outbreak caused by the very similar virus SARS-CoV-1 to advise endocrinologists involved in the care of patients with COVID-19,‚ÄĚ said¬†Noel¬†Pratheepan¬†Somasundaram of the National Hospital of Sri Lanka in Colombo, Sri Lanka. ‚ÄúThe virus that causes COVID-19‚ÄĒSARS-CoV-2‚ÄĒbinds to the¬†ACE2 receptor,¬†a protein¬†which is expressed in many tissues.¬†This allows the virus¬†to enter¬†endocrine¬†cells and cause the mayhem associated with the disease.‚ÄĚ

SARS-CoV
2 can cause loss of smell and gain entry to the brain. In past coronavirus infections such as the SARS epidemic in 2003, many patients developed a post-viral syndrome with fatigue. This could in part be caused by adrenal insufficiency, a condition where the adrenal glands do not make enough cortisol, as a result of damage to the pituitary system. During the SARS epidemic, patients who developed adrenal insufficiency typically recovered within one year.

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Testing for cortisol deficiency and treating patients with¬†steroids¬†may become a vital treatment strategy,‚Ä̬†Somasundaram¬†said. ‚ÄúVery recent studies have demonstrated lowered mortality in severely-ill patients with COVID-19 treated with¬†the steroid¬†dexamethasone.‚ÄĚ

COVID-19 also 
could lead to new cases of diabetes and worsening of existing diabetes. The SARS-CoV-2 virus attaches to ACE2, the main entry point into cells for coronavirus, and disrupts insulin production, causing high blood glucose levels in some patients. The authors highlight the need for strict glucose monitoring in patients with COVID-19 as a measure to maximize recovery.

People¬†with vitamin D¬†deficiency may¬†be more¬†susceptible¬†to¬†coronavirus¬†and supplementation could improve outcomes, though evidence on the subject is mixed,‚ÄĚ Somasundaram said.

Reference: Somasundaram, et al (2020). The Impact of SARS-Cov-2 Virus Infection on the Endocrine System. Journal of the Endocrine Society. DOI: https://doi.org/10.1210/jendso/bvaa082

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.