tetano
Editor, Senior Moderator
Cureus
. 2022 May 3;14(5):e24702.
doi: 10.7759/cureus.24702. eCollection 2022 May.
Endocrine and Metabolic Manifestations of COVID-19 Patients Admitted to an Intensive Care Unit
Saurabh Arora[SUP] 1 [/SUP], Akashdeep Singh[SUP] 2 [/SUP], Vipin Kumar[SUP] 3 [/SUP], Bishav Mohan[SUP] 4 [/SUP], Rajesh Mahajan[SUP] 3 [/SUP], Navdeep Singh[SUP] 5 [/SUP], Parminder Singh[SUP] 1 [/SUP], Naveen Mittal[SUP] 1 [/SUP], Suman Sethi[SUP] 1 [/SUP], Sarit Sharma[SUP] 6 [/SUP], Sanjay Kalra[SUP] 7 [/SUP], Nitin Kapoor[SUP] 8 [/SUP], Saloni Goyal[SUP] 9 [/SUP]
Affiliations
Abstract
Context: The effects of coronavirus disease 2019 (COVID-19) on the endocrine system remain uncertain.
Objective: Our study aimed to explore the possible effects of COVID-19 on endocrine organs and to determine the impact of glycemic status, 25-hydroxyvitamin D levels, calcium levels, and thyroid dysfunction on the final outcome of patients with COVID-19.
Design and methods: This single-center, retrospective study evaluated endocrine function abnormalities in 102 patients hospitalized with COVID-19 in the intensive care unit (ICU).
Results: Of 102 patients admitted to ICU, 42 (41.2%) succumbed to illness. The most frequently observed abnormality in thyroid function tests was low free triiodothyronine (FT3) levels (56%). A thyroid profile indicating thyrotoxicosis was detected in five (4.9%) patients, and overt hypothyroidism was identified in two (1.9%) patients. New-onset diabetes was detected in five (4.9%) patients whereas diabetic ketoacidosis at presentation was found in six (5.9%) cases. Rhino-orbital mucormycosis was detected in one patient with diabetes during treatment of COVID-19 while three (2.9%) patients were diagnosed with pulmonary mucormycosis after recovery from COVID-19. Hypocalcemia was observed in 52 (51 %) patients. Out of 42 patients who died, 32 patients had low FT3, 26 patients had high glycated haemoglobin (HbA1c), and 33 patients had low 25-hydroxyvitamin D. Multivariate analysis demonstrated that low concentration of 25-hydroxyvitamin D, low FT3 and higher HbA1c levels were significantly associated with increased mortality.
Conclusion: New-onset thyrotoxicosis in COVID-19 patients is mostly due to subacute thyroiditis. Hypocalcemia is also frequently encountered in patients with moderate disease and those with critical COVID-19. A high index of suspicion is required to timely diagnose mucormycosis in COVID-19 patients with diabetes.
Keywords: diabetic ketoacidosis; hypocalcemia; pulmonary mucormycosis; rhino-orbital mucormycosis; thyrotoxicosis.
. 2022 May 3;14(5):e24702.
doi: 10.7759/cureus.24702. eCollection 2022 May.
Endocrine and Metabolic Manifestations of COVID-19 Patients Admitted to an Intensive Care Unit
Saurabh Arora[SUP] 1 [/SUP], Akashdeep Singh[SUP] 2 [/SUP], Vipin Kumar[SUP] 3 [/SUP], Bishav Mohan[SUP] 4 [/SUP], Rajesh Mahajan[SUP] 3 [/SUP], Navdeep Singh[SUP] 5 [/SUP], Parminder Singh[SUP] 1 [/SUP], Naveen Mittal[SUP] 1 [/SUP], Suman Sethi[SUP] 1 [/SUP], Sarit Sharma[SUP] 6 [/SUP], Sanjay Kalra[SUP] 7 [/SUP], Nitin Kapoor[SUP] 8 [/SUP], Saloni Goyal[SUP] 9 [/SUP]
Affiliations
- PMID: 35663648
- PMCID: PMC9162892
- DOI: 10.7759/cureus.24702
Abstract
Context: The effects of coronavirus disease 2019 (COVID-19) on the endocrine system remain uncertain.
Objective: Our study aimed to explore the possible effects of COVID-19 on endocrine organs and to determine the impact of glycemic status, 25-hydroxyvitamin D levels, calcium levels, and thyroid dysfunction on the final outcome of patients with COVID-19.
Design and methods: This single-center, retrospective study evaluated endocrine function abnormalities in 102 patients hospitalized with COVID-19 in the intensive care unit (ICU).
Results: Of 102 patients admitted to ICU, 42 (41.2%) succumbed to illness. The most frequently observed abnormality in thyroid function tests was low free triiodothyronine (FT3) levels (56%). A thyroid profile indicating thyrotoxicosis was detected in five (4.9%) patients, and overt hypothyroidism was identified in two (1.9%) patients. New-onset diabetes was detected in five (4.9%) patients whereas diabetic ketoacidosis at presentation was found in six (5.9%) cases. Rhino-orbital mucormycosis was detected in one patient with diabetes during treatment of COVID-19 while three (2.9%) patients were diagnosed with pulmonary mucormycosis after recovery from COVID-19. Hypocalcemia was observed in 52 (51 %) patients. Out of 42 patients who died, 32 patients had low FT3, 26 patients had high glycated haemoglobin (HbA1c), and 33 patients had low 25-hydroxyvitamin D. Multivariate analysis demonstrated that low concentration of 25-hydroxyvitamin D, low FT3 and higher HbA1c levels were significantly associated with increased mortality.
Conclusion: New-onset thyrotoxicosis in COVID-19 patients is mostly due to subacute thyroiditis. Hypocalcemia is also frequently encountered in patients with moderate disease and those with critical COVID-19. A high index of suspicion is required to timely diagnose mucormycosis in COVID-19 patients with diabetes.
Keywords: diabetic ketoacidosis; hypocalcemia; pulmonary mucormycosis; rhino-orbital mucormycosis; thyrotoxicosis.