Endocrine Responses to COVID-19 Infection
Summary
The endocrine system exhibits a complex response to SARS-CoV-2 infection, reflecting both direct viral effects and host inflammatory reactions. Many endocrine organs express the angiotensin-converting enzyme 2 (ACE2) receptor, facilitating direct viral entry into tissues such as the adrenal cortex, thyroid gland and pancreatic islets. Severe inflammation and cytokine release can disrupt regulatory feedback loops, leading to dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, altered thyroid hormone metabolism and impaired gonadal function. Acute presentations range from transient low-T3 syndrome and sick euthyroid patterns to adrenal insufficiency and hypogonadism, while glucose homeostasis may be disturbed by pancreatic injury or systemic stress, precipitating hyperglycaemia and new-onset diabetes. A hypercoagulable state further predisposes to vascular events in endocrine organs, such as adrenal infarction. Although many abnormalities are reversible, persistent symptoms—especially fatigue—underscore the need for longitudinal monitoring of endocrine recovery. Understanding these mechanisms has practical implications for risk stratification, hormonal replacement strategies and minimising long-term sequelae in survivors of COVID-19.
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Endocrine Responses to COVID-19 Infection publication trend
The graph below shows the total number of articles in endocrine responses to covid-19 infection across all publications each year (not limited to Nature Index journals).
Technical terms
Angiotensin-converting enzyme 2 (ACE2): A transmembrane enzyme that serves as the entry receptor for SARS-CoV-2 in multiple tissues.
Hypothalamic–pituitary–adrenal (HPA) axis: The hormonal cascade involving corticotrophin-releasing hormone, adrenocorticotropic hormone and cortisol, central to stress responses.
Sick euthyroid syndrome: A pattern of low peripheral thyroid hormones with normal thyroid-stimulating hormone, reflecting altered metabolism during systemic illness.
Critical illness–related corticosteroid insufficiency (CIRCI): Inadequate cortisol production relative to stress demands in critically ill patients, potentially requiring replacement therapy.
References
- Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infectious Diseases of Poverty (2020).
- Endocrine Significance of SARS-CoV-2’s Reliance on ACE2. Endocrinology (2020).
- Spectrum of Endocrine Dysfunction and Association With Disease Severity in Patients With COVID-19: Insights From a Cross-Sectional, Observational Study. Frontiers in Endocrinology (2021).
- The Adrenal Cortex, an Underestimated Site of SARS-CoV-2 Infection. Frontiers in Endocrinology (2021).
- Normal Adrenal and Thyroid Function in Patients Who Survive COVID-19 Infection. The Journal of Clinical Endocrinology & Metabolism (2021).
- A case of adrenal infarction in a patient with COVID 19 infection. BJR|case reports (2020).
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