Abstract 148: Endocrine dysfunction in Covid-19 recovered individuals

Background: Involvement of the endocrine system has been well characterized in the acute stage of COVID-19. Long-term sequelae of COVID-19 involving various systems with a negative impact on mental health, well-being, and quality of life have been reported. Observational studies from different populations revealed a variable proportion of endocrine dysfunction following SARS-CoV-2 infection. The spectrum ranges from normal function to the persistence or emergence of new dysfunction up to 12 weeks post-COVID. Objective: To determine the spectrum of endocrine dysfunction in COVID-19-recovered individuals. Methods: Patients were recruited 8-20 weeks following recovery from COVID-19. They were further stratified according to disease severity as defined by the ICMR criteria. Demographic and clinical details, physical examination, basal and stimulated cortisol, DHEAS, ACTH, TSH, fT4, fT3, LH, FSH, Testosterone, SHBG, AMH, prolactin, fasting blood glucose (FBG), Hba1c, insulin, c-peptide levels with calculated HOMA-IR and HOMA-beta were done. Results: Eighty-three subjects were recruited of which 33 (39.7%) and 50 (60.3%) belonged to mild and moderate to severe COVID respectively. There were 50 male and 33 female subjects. The mean duration after recovery was 14.7 weeks. Sixty-nine subjects (83%) had new or persistent symptoms. Thirty-seven subjects (44.6%) had some form of endocrine dysfunction. Thyroid function abnormalities were observed in 18 subjects (21.6%) [Subclinical hypothyroidism (18.1%), overt hypothyroidism (1.2%), Central hypothyroidism (2.4%)]. Primary and Secondary adrenal insufficiency was documented in 1 (1.2%) and 15 (18.1%) subjects respectively. A higher prevalence of adrenal insufficiency was noted among those who received steroids (62.5% vs. 37.5%). Hypogonadism was observed in 10 males [Primary 2 (4%) and Secondary 8 (16%)]. Central endocrine dysfunction involving two axes was noted in 3 patients. There was no association was between the severity of COVID and any of these endocrine dysfunctions. Among 67 patients with no history of Diabetes Mellitus (DM), 6 (9%) patients had dysglycemia [3 new-onset DM and 3 Pre DM]. Significant differences were also noted between the means of waist circumference (p = 0.003), FBS (p = 0.02), HOMA IR by insulin (p = 0.04) and c-peptide (p = 0.001) among non-DM patients when compared for disease severity [mild (n = 29) vs. moderate-severe (n = 38)]. Conclusion: Our study highlights that endocrine dysfunction involving different endocrine axis can be seen up to 20 weeks post-COVID in patients with no prior history of endocrine disorder. The most common dysfunction observed was of the thyroid followed by the adrenal axis.