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The endocrine system is a major network that integrates metabolic and hormonal signals in the human body. It encompasses a large system of organs including the pituitary gland, thyroid, adrenal gland, reproductive organs, pancreas, and bone.1 Any environmental changes or perturbations are likely to have long-lasting effects on multiple endocrine axes.2 Pandemics or other types of crises often result in stressful events that affect normal endocrine signaling, resulting in alterations in baseline endocrine function or exacerbation of pre-existing conditions. Further, some events are impactful enough to fundamentally change the approach to the practice of endocrinology and can alter usual clinical practices and guidelines. We are currently experiencing such a shift as we progress through the coronavirus disease 2019 (COVID-19) pandemic, which has caused greater than 110 million infections worldwide and > 2.4 million deaths. The viral infection is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acute COVID-19 viral infection has been shown to have significant effects on multiple endocrine organs and systems, some of which are short-lived but others that can persist for a long time (see Table 9-1). Recent viral pandemics such as severe acute respiratory syndrome (SARS) in 2003 and middle east respiratory syndrome (MERS) in 2012 were associated with pituitary dysfunction, adrenal insufficiency, impaired glycemic control associated with lability in glycemic excursions, and increased insulin resistance.3–6 Of significant interest is the mechanism by which newly discovered pathogens like SARS CoV-2 may choose to utilize metabolic pathways such as the renin angiotensin-aldosterone system (RAAS) and the angiotensin converting enzyme-2 (ACE-2) receptor more specifically as the entry point of infection to cells. This pathway has significant importance as it is readily activated in multiple endocrine systems. Given the consequences of these burgeoning pandemics on the metabolic milieu, it seems plausible that a deliberate and structured approach to the identification and management of endocrine and metabolic disorders is essential to adaptation during times of crisis. Here we will present a general overview on how crises may affect the manifestation of endocrine disorders. More specifically, we will review how the current COVID-19 pandemic has affected the endocrine pathways and axes, the current information and the current knowledge that has been gained, and insights on how to better prepare for emerging crises.



In general, the stress response is mediated primarily by the corticotrophin-releasing hormone (CRH) and ...

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