key: cord-0906115-h9krjk2d authors: Pal, Rimesh; Joshi, Ameya; Bhadada, Sanjay K.; Banerjee, Mainak; Vaikkakara, Suresh; Mukhopadhyay, Satinath title: Endocrine Follow-Up During Post-Acute COVID-19: Practical Recommendations Based On Available Clinical Evidence date: 2022-02-11 journal: Endocr Pract DOI: 10.1016/j.eprac.2022.02.003 sha: b86a7e053f7e1f83881667ca9d05b8dc7fc9db0c doc_id: 906115 cord_uid: h9krjk2d COVID-19 affects multiple endocrine organ systems during the disease course. However, follow-up data post-COVID is scarce; hitherto available limited data suggests that most of the biochemical endocrine dysfunctions observed during the acute phase of COVID-19 tend to improve after recovery. Thus, a rational approach towards endocrine follow-up of patients post-acute COVID-19 needs to be undertaken. We performed a literature review across PubMed/MEDLINE database on the effects of COVID-19 on the endocrine system and subsequent long-term sequelae on endocrine functions. Accordingly, we have presented a practical set of recommendations regarding the endocrine follow-up post-acute COVID-19. COVID-19 can lead to new-onset hyperglycemia/diabetes mellitus or worsening of dysglycemia in patients with pre-existing diabetes mellitus. Hence, those with pre-existing diabetes mellitus should ensure optimum glycemic control in the post-COVID period. New-onset diabetes mellitus has been described post-acute COVID-19; hence, a selected group of patients (age <70 years, those requiring ICU admission) might be screened for the same at 3 months. Thyroid dysfunction (sick euthyroid syndrome, atypical thyroiditis) and adrenal insufficiency have been described in COVID-19; however, thyroid/adrenal functions usually normalize on follow-up, hence, widespread screening post-acute COVID-19 should not be recommended. Pituitary apoplexy and male hypogonadism have rarely been documented in COVID-19; therefore, appropriate follow-up might be undertaken as per the clinical context. Hypocalcemia during COVID-19 is not uncommon, however, routine estimation of serum calcium post-COVID is not warranted. The recommendations herein provide a rational approach that would be expected to guide physicians to better delineate and manage the endocrine sequelae during post-acute COVID-19. rational approach that would be expected to guide physicians to better delineate and 26 manage the endocrine sequelae during post-acute COVID-19. The common symptoms observed in post-acute COVID-19 include fatigue, poor 59 quality of life, muscle weakness, joint pain, dyspnea, cough, decreased exercise 60 capacity, and persistent oxygen requirement. In a cohort of individuals with COVID-61 19 who were followed up for 9 months after illness, approximately 30% reported 62 persistent symptoms. One-third of outpatients with mild disease also reported 63 persistent symptoms. Fatigue was the most commonly reported symptom in the cohort 64 with COVID-19 who were admitted to the hospital and subsequently discharged by 127 August 31, 2020 were included. Cases were matched to controls for personal and 128 clinical characteristics; controls were recruited from a pool of nearly 50 million 129 people retrieved from an electronic health database. After discharge, diabetes was 130 diagnosed in 4.9% of COVID-19 survivors, amounting to a rate of 127 per 1000 131 person-years. Individuals who needed to be admitted to the intensive care unit (ICU) 132 had higher rates of diabetes (8.8%) after discharge than those who did not require ICU 133 admission (4.6%). The rate ratio was higher for individuals aged less than 70 years 134 than those 70 years or older (16). 135 Apart from diabetes mellitus, metabolic syndrome is also independently associated 136 is more commonly reported. COVID-19-associated SAT is biochemically 204 characterized by low TSH, low free T3 (fT3), and normal or elevated free T4 (fT4). In 205 the context of COVID-19, such an entity is often referred to as atypical thyroiditis 206 (27) and should be considered a differential diagnosis when acutely infected patients 207 present with tachycardia without evidence of progression COVID-19 illness (28). 208 Although follow-up data are limited, most of the available data suggest that thyroid 209 function returns to normal without treatment (23-25). 210 Subacute thyroiditis has also been described after recovery from COVID-19 (29-31). 211 Such patients tend to present with neck pain, fever resurgence, weight loss, and/or 212 palpitations (32). In addition, occasional cases of Graves' disease have been described 213 following COVID-19 (33-35). In a prospective observational study, 70 patients aged 214 18 years or above were included at least 3 months after the diagnosis of COVID-19. Besides, SARS-CoV-2 has also been detected in testes of patients with severe disease 361 (53). 362 The risk of impaired spermatogenesis has also been observed in patients with 363 moderate infection and convalescents (51,54). In an observational study that had 364 involved 43 sexually active men who had recovered from COVID-19, oligo-crypto-365 azoospermia was seen in 25.6% of the patients. The severity of COVID-19 was 366 related to the occurrence of azoospermia. Azoospermia was observed in 80%, 11.5% The herein proposed recommendations have been summarized in Table 1 . patient infected with SARS-COV-2: an endocrine complication 606 linked to the COVID-19 pandemic Subacute Thyroiditis in the Setting 608 of Coronavirus Disease 2019 COVID-19-related 610 thyroiditis: A novel disease entity? SARS-COV-2 as a trigger for autoimmune 612 disease: report of two cases of Graves' disease after COVID-19 Graves' disease and Graves' orbitopathy 615 following COVID-19 Manifestations of thyroid disease post COVID-617 19 illness: Report of Hashimoto thyroiditis, Graves' disease, and subacute 618 thyroiditis Pal R. COVID-19, hypothalamo-pituitary-adrenal axis and clinical implications Association 629 between high serum total cortisol concentrations and mortality from COVID-19 Cortisol 633 concentrations and mortality from COVID-19 -Authors' reply Could serum total cortisol level at admission predict 636 mortality due to coronavirus disease 2019 in the intensive care unit? A 637 prospective study Underestimated Site of SARS-CoV-2 Infection Delayed Onset of Central Hypocortisolism in a Patient 651 Recovering From COVID-19 Central diabetes insipidus 656 (Infundibuloneuro hypophysitis): A late complication of COVID-19 infection Endocrinol Invest Effect of serum total testosterone and its 660 relationship with other laboratory parameters on the prognosis of coronavirus 661 disease 2019 (COVID-19) in SARS-CoV-2 infected male patients: a cohort 662 study Low testosterone levels predict clinical adverse outcomes in SARS-CoV-2 665 pneumonia patients Autopsy of COVID-19 patients in China Assessment of SARS-CoV-2 in human semen-a cohort study Semen 682 impairment and occurrence of SARS-CoV-2 virus in semen after recovery from 683 COVID-19 Ory and menstruation in COVID-19 women of child-bearing age Ovarian follicular function is not altered by SARS-CoV-2 infection or BNT162b2 mRNA COVID-19 vaccination Hypocalcemia is highly prevalent and predicts hospitalization in patients with 698 COVID-19 Serum 700 Calcium and Vitamin D levels: Correlation with severity of COVID-19 in 701 hospitalized patients in Royal Hospital High 704 Prevalence of Hypocalcemia in Non-severe COVID-19 Patients: A 705 Retrospective Case-Control Study Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Low Serum 25-710 hydroxyvitamin D (Vitamin D) Level Is Associated With Susceptibility to COVID-19, Severity, and Mortality: A Systematic Review and Meta-Analysis Hypocalcemia in COVID-19 is associated with low vitamin D levels and 715 impaired compensatory PTH response Vitamin D 717 supplementation and clinical outcomes in COVID-19: a systematic review and 718 meta-analysis Long-term clinical and 720 biochemical residue after COVID-19 recovery COVID-19 and 722 endocrine and metabolic diseases. An updated statement from the European 723 Society of Endocrinology COVID-19 vaccination in patients with diabetes 725 mellitus: Current concepts, uncertainties and challenges Vaccination for Endocrine Patients: A Position Statement from the Korean 729 Thyrotoxicosis after COVID-19 vaccination: seven 731 case reports and a literature review Thyroid as a target of adjuvant autoimmunity/inflammatory syndrome due to thyroiditis A case of Graves' disease and 738 type 1 diabetes mellitus following SARS-CoV-2 vaccination -2 Vaccine: Case Series Post-COVID-vaccine autoimmune/inflammatory 744 syndrome in response to adjuvants (ASIA syndrome) manifesting as subacute 745 thyroiditis