The effects of COVID-19 go beyond the respiratory system, causing consequences for several months after original infection.

Within the framework of the Master Conference Series carried out by the Puerto Rico Public Health Trust, several health specialists made different interventions on the COVID-19 disease, the importance of its early detection and its impact on the body. In particular, the Director of Endocrinology, of the School of Medicine – RCM, Dr. Margarita Ramírez, referred to the endocrine system and how the virus has affected it.

Several have been published case reports with stroke pituitary when diagnosed with COVID-19 and although the most had risk factorsin some cases they occurred in microadenomas and without evidence of tumor.

Thyroid-related COVID is believed to have a direct effect of the virus from the most central part in the pituitary, causing secondary hypothyroidism. Additionally, severe damage to thyroid follicular cells has been found following infection.

“Early in the pandemic, several cases of subacute thyroiditis were reported, occurring two to four weeks after the symptoms of covid resolved,” Ramírez said.

This tends to be atypical, since in most cases it does not cause pain in the neck area, but causes lymphopenia instead of lymphocytosis. Similarly, it has been shown that those infected with COVID-19 were more likely to develop hyperthyroidism.

“It is not a destruction of the cells, but a damage mediated by the immune response,” said Dr. Margarita Ramírez. Some cases of subacute thyroiditis associated with vaccination against SARS-Cov-2 have been reported.

Grave’s disease

Several cases have been reported in relation to COVID-19 infection, since it generates an exaggerated response of cytokines, causing a reaction autoimmune disease trigger in the thyroid.

It is important to highlight that the reports of the development of Grave’s disease is from six to eight weeks after the vaccine, specifically the mRNa vaccine for Sarscov-2

Nonthyroidal illness syndrome

This occurs as a response physiology during critical illness and is not due to thyroid dysfunction.

This condition will progress to a decrease in T3, T4 and TSH during the period of stress; It is necessary to clarify that if the patient recovers from this disease, his thyroid tests will return to normal. This type of pattern is evident in those people to whom this condition is related to COVID.

In the event that COVID presents itself with a higher viral load and severity, thyroid test results in patients they return to normal in three to six months after infection.

On the other hand, if the patient has the type of variant known as persistent COVID-19, which is characterized by fatigue, myalgia, and mental confusion, these could cause a confusion with own symptoms of the thyroid.

“Until now, no endocrinologist has known that they have had patients with alterations in their secondary thyroid tests after a COVID-19 infection,” Dr. Margarita Ramírez pointed out.

adrenal gland

During the first outbreak of COVID-19, it was reported that almost 40% of those infected presented adrenal insufficiency in their laboratory tests, more than three months after infection. On the other hand, the autopsies performed showed hemorrhages, necrosis and inflammation in the adrenal glands.

Additionally, heart attacks and adrenal hemorrhages were reported in acute infection, in many cases the causes could be due to other conditions and not COVID.

In most patients, adrenal function tends to be preserved during the first 48 hours after admission; however, there will be an increase in cortisol expected for critical illness, which will be related to the severity and a worse outcome of the disease. However, no cases of adrenal insufficiency have been confirmed by the laboratory to date.

On the other hand, through the Recovery study, a decrease in the mortality rate was demonstrated with the use of dexamethasone in patients who required oxygen therapy, for this reason it was used as part of the necessary therapies in this condition.

As with thyroid symptoms, the signs of persistent COVID can be confused with adrenal insufficiency. In contrast, these symptoms have not been found to correlate with glucocorticoid deficiency.

However, it should be emphasized that some cases of adrenal insufficiency have been reported after an acute episode of the disease, in some of these cases it may be due to transitory alterations in the pituitary-adrenal axis due to the use of glucocorticoids as therapy for COVID .

the gonads

These can be affected by COVID-19, especially the testicles. This is because damage to the testicles by SARS-Cov-2 has been found in biopsies, causing a significant loss of germ cells.

“Therefore, it is not yet known whether this may have long-term implications for the fertility of these patients,” Dr. Margarita Ramírez clarified.

In relation to the ovaries, it has not been possible to demonstrate an effect of COVID, however, a development of long-term menstrual irregularities has been seen in infected patients, “and it is one of the conditions that we have seen in clinic, of women who after months of developing the covid infection have maintained menstrual irregularity,” said Dr. Margarita Ramírez.

Keep in mind that a woman’s reproductive axis can also be affected by factors such as stress, mood swings, and weight gain.

On the other hand, the association of SARS-Cov-2 with changes in sex hormones in women is not clear.

The pancreas

A bidirectional relationship between type 2 diabetes and COVID-19 has been evidenced since the beginning of the pandemic.

The control of this diabetes can increase the severity of the infection and is associated with greater morbidity, causing in many cases an increase in the mortality rate. It is important to clarify that there is a greater progression from prediabetes to diabetes.

Similarly, an increase was seen in diabetes induced by steroids that have been used as part of the treatment of infection.

One factor that should be highlighted is that obesity, which is frequently associated with diabetes, predicts COVID hospitalizations, intubation, and higher mortality, especially in patients with severe and visceral obesity.

Through biopsies, it has been detected that in patients infected with COVID, the virus in the Beta cells of the pancreas: “and in those who have a diagnosis of diabetes, either type 1 or type 2, much higher doses of insulin are needed. and mortality has been higher, especially if they were uncontrolled prior to infection” commented Dr. Margarita Ramírez.

Similarly, several cases of de novo type 1 diabetes development have been reported, without the detection of antibodies, suggesting that the virus can cause destruction of the islets of the pancreas. Likewise, it has been possible to demonstrate the development of ketoacidosis in non-typical populations, such as: patients with type 2 diabetes, older people and non-Caucasians.

Due to this, it is not known for sure what the long-term effects of those patients who develop de novo hyperglycemia with SARS-CoV-2 infection could be, however, one study found that a third persisted with hyperglycemia for six months after infection and 2% remained with frank diabetes.

In conclusion, the endocrine system is particularly vulnerable to being disturbed by COVID-19 infection, especially in thyroid dysfunction and hyperglycemia. Persistent COVID can be a challenge for the health system and the degree of disturbance it can cause in the endocrine system.