SARS‐CoV‐2 infection and paediatric endocrine disorders: Risks and management considerations

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Abstract

Background

Coronavirus‐19 (COVID‐19) is a disease caused by the SARS‐CoV‐2 virus, the seventh coronavirus identified as causing disease in humans. The SARS‐CoV‐2 virus has multiple potential pathophysiologic interconnections with endocrine systems, potentially causing disturbances in glucose metabolism, hypothalamic and pituitary function, adrenal function and mineral metabolism. A growing body of data is revealing both the effects of underlying endocrine disorders on COVID‐19 disease outcome and the effects of the SARS‐CoV‐2 virus on endocrine systems. However, comprehensive assessment of the relationship to endocrine disorders in children has been lacking.

Content

In this review, we present the effects of SARS‐CoV‐2 infection on endocrine systems and review the current literature on complications of COVID‐19 disease in underlying paediatric endocrine disorders. We provide recommendations on management of endocrinopathies related to SARS‐CoV‐2 infection in this population.

Summary and outlook

With the surge in COVID‐19 cases worldwide, it is important for paediatric endocrinologists to be aware of the interaction of SARS‐CoV‐2 with the endocrine system and management considerations for patients with underlying disorders who develop COVID‐19 disease. While children and adults share some risk factors that influence risk of complications in SARS‐CoV‐2 infection, it is becoming clear that responses in the paediatric population are distinct and outcomes from adult studies cannot be extrapolated. Evidence emerging from paediatric studies provides some guidance but highlights the need for more research in this area.

Abstract

The SARS‐CoV‐2 virus has multiple potential pathophysiologic interconnections with endocrine systems. In this review, we present the effects of SARS‐CoV‐2 infection on endocrine systems and review the current literature on complications of COVID‐19 disease in underlying paediatric endocrine disorders. We provide recommendations on management of endocrinopathies related to SARS‐CoV‐2 infection in this population.

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Most cited references 83

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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

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Author and article information

Contributors

Ryan Miller:

ORCID: https://orcid.org/0000-0002-2656-7211

rmiller@som.umaryland.edu

Journal

Journal ID (nlm-ta): Endocrinol Diabetes Metab

Journal ID (iso-abbrev): Endocrinol Diabetes Metab

Journal ID (doi): 10.1002/(ISSN)2398-9238

Journal ID (publisher-id): EDM2

Title: Endocrinology, Diabetes & Metabolism

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2398-9238

Publication date (Electronic): 03 June 2021

Electronic Location Identifier: e00262

Affiliations

[ ¹ ] Department of Pediatrics University of Maryland School of Medicine Baltimore MD USA

[ ² ] Department of Pediatrics University of Alabama at Birmingham Birmingham AL USA

[ ³ ] Department of Pediatrics Georgetown University Washington D.C. USA

[ ⁴ ] Department of Pediatrics Children's Hospital of Richmond at Virginia Commonwealth University Richmond VA USA

[ ⁵ ] Department of Pediatrics Nationwide Children's Hospital The Ohio State University Columbus OH USA

[ ⁶ ] Department of Pediatrics NYU Langone Medical Center New York NY USA

[ ⁷ ] Department of Pediatrics University of Tennessee Health Sciences Center Le Bonheur Children's Hospital Memphis TN USA

[ ⁸ ] Department of Pediatrics New York Medical College New York NY USA

[ ⁹ ] Pediatric Endocrine Unit Massachusetts General Hospital for Children Boston MA USA

[ ¹⁰ ] Department of Pediatrics Milton S. Hershey Medical Center Hershey PA USA

[ ¹¹ ] Department of Pediatrics University of Utah Salt Lake City UT USA

[ ¹² ] Diabetes and Endocrinology Center University of South Florida Tampa FL USA

[ ¹³ ] Department of Pediatrics and Department of Medicine University of Chicago Chicago IL USA

[ ¹⁴ ] University of Oklahoma Health Sciences Center Oklahoma City OK USA

Author notes

[*] [* ] Correspondence

Ryan Miller, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.

Email: rmiller@ 123456som.umaryland.edu

Author information

Ryan Miller https://orcid.org/0000-0002-2656-7211

Ambika P. Ashraf https://orcid.org/0000-0003-0692-6624

Evgenia Gourgari https://orcid.org/0000-0002-5788-7955

Article

Publisher ID: EDM2262

DOI: 10.1002/edm2.262

PMC ID: 8209869

SO-VID: db9ccc7a-2fd2-449e-870c-d24c60a58180

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date revision received : 30 March 2021

Date received : 02 February 2021

Date accepted : 30 April 2021

Page count

Figures: 2, Tables: 0, Pages: 8, Words: 19108

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details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:17.06.2021

Keywords: covid‐19,paediatric endocrine disorders,sars‐cov‐2

Data availability:

Keywords: covid‐19, paediatric endocrine disorders, sars‐cov‐2

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SARS‐CoV‐2 infection and paediatric endocrine disorders: Risks and management considerations

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Abstract

Background

Content

Summary and outlook

Abstract

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Novel Coronavirus Disease COVID-19

Most cited references 83

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

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Cited by 4

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