The Impact of SARS-Cov-2 Virus Infection on the Endocrine System.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has spread across the globe rapidly causing an unprecedented pandemic. Because of the novelty of the disease, the possible impact on the endocrine system is not clear. To compile a mini-review describing possible endocrine consequences of SARS-CoV-2 infection, we performed a literature survey using the key words Covid-19, Coronavirus, SARS CoV-1, SARS Cov-2, Endocrine, and related terms in medical databases including PubMed, Google Scholar, and MedARXiv from the year 2000. Additional references were identified through manual screening of bibliographies and via citations in the selected articles. The literature review is current until April 28, 2020. In light of the literature, we discuss SARS-CoV-2 and explore the endocrine consequences based on the experience with structurally-similar SARS-CoV-1. Studies from the SARS -CoV-1 epidemic have reported variable changes in the endocrine organs. SARS-CoV-2 attaches to the ACE2 system in the pancreas causing perturbation of insulin production resulting in hyperglycemic emergencies. In patients with preexisting endocrine disorders who develop COVID-19, several factors warrant management decisions. Hydrocortisone dose adjustments are required in patients with adrenal insufficiency. Identification and management of critical illness-related corticosteroid insufficiency is crucial. Patients with Cushing syndrome may have poorer outcomes because of the associated immunodeficiency and coagulopathy. Vitamin D deficiency appears to be associated with increased susceptibility or severity to SARS-CoV-2 infection, and replacement may improve outcomes. Robust strategies required for the optimal management of endocrinopathies in COVID-19 are discussed extensively in this mini-review.

Outcomes of offspring born to mothers with gestational diabetes.

With the global explosion of Diabetes and obesity at epidemic proportions, keeping Asia at its epicenter, 1 in 7 live births get complicated with hyperglycaemia; either pre-existing Diabetes or Gestational Diabetes. In utero, exposure to an adverse metabolic environment with nutrient excess or deficiencies and toxic metabolites with teratogenic potential, leads to short and long term consequences to the offspring. Multisystemic congenital malformations, macrosomia associated obstetric complications and perinatal metabolic derangements complicate the early neonatal stage. Epigenetic changes taking place during foetal development initiate foetal metabolic programming and create adverse metabolic memory leading to childhood obesity, metabolic syndrome and Diabetes. Hyperglycaemia and poor metabolic parameters throughout pregnancy correlate with adverse offspring outcomes. Novel management strategies targeting near normoglycaemia have achieved marked improvements in rates of perinatal mortality and other adverse outcomes. Therapies for management of Diabetes in pregnancy should be carefully selected upon the safety profile for the offspring.