BREAKING NEWS! Italian Study Reveals That SARS-CoV-2 Is Able To Affect The Pituitary Gland Leading To Possible Hypopituitarism And A Variety Of Disorders!

COVID-19-Pituitary Gland: More worrisome study findings have emerged from a research conducted by Italian neurology scientists from Università Vita-Salute San Raffaele , Milan-Italy along with support from the Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health and Science University-U.S.A in which it has been found that the SARS-CoV-2 coronavirus is able to affect the human host pituitary gland and possibly cause hypopituitarism and also a variety of pituitary gland abnormalities and disorders along with disrupting various metabolic functions. The study also found that existing pituitary gland disorders and existing hypopituitarism prior to SARS-CoV-2 infections can also aggravate COVID-19 outcomes including disease severity and increased risk of mortality.

Aside from the pulmonary manifestations caused by the SARS-CoV-2 coronavirus, an emerging endocrine phenotype, which can heavily impact on the severity of the syndrome, has been recently associated with the COVID-19 disease.
 
Patients with pituitary diseases or the pituitary gland itself may also be involved in COVID-19 clinical presentation and/or severity, causing pituitary apoplexy.
 
Furthermore the condition of hypopituitarism is frequently burdened by several metabolic complications, including arterial hypertension, hyperglycemia, obesity and vertebral fractures, which have all been associated with poor outcomes and increased mortality in patients infected by SARS-CoV-2.
 
The study findings report hypopituitarism as a condition that might have a bidirectional relationship with COVID-19 due to the frequent presence of metabolic comorbidities, to the direct or indirect pituitary damage or being per se a potential risk factor for COVID-19.
 
The study findings also address the current recommendations for the clinical management of vaccines in patients with hypopituitarism and adrenal insufficiency.
 
The study findings were published in the peer reviewed journal:  Reviews in Endocrine and Metabolic Disorders. https://rd.springer.com/article/10.1007/s11154-021-09672-y
 
The pituitary gland is a small pea-sized gland that plays a major role in regulating vital body functions and general wellbeing. It is referred to as the body's 'master gland' because it controls the activity of most other hormone-secreting glands including the thyroid and adrenals, the ovaries and testicles.  It is located at the base of your brain, behind the bridge of your nose and directly below your hypothalamus. It sits in an indent in the sphenoid bone called the sella turcica. The pituitary gland is one of eight interrelated major endocrine glands. The pituitary gland secretes hormones from both the front part (anterior) and the back part (posterior) of the gland. Hormones are chemicals that carry messages from one cell to another through your bloodstream. If the pituitary gland is not producing sufficient amounts of one or more hormones this is called hypopituitarism.
 
To date, the SARS-CoV-2 coronavirus which is the pathogen  responsible for the coronavirus disease 2019 (COVID-19), has in fected over 221 million and caused the deaths of over 4.6 million worldwide. Although COVID-19 has been traditionally associated with its ability to cause varied symptoms resembling acute respiratory distress syndrome (ARDS), emerging scientific evidence has demonstrated that SARS-CoV-2 causes much more damage beyond its effects on the upper respiratory tract. Scientists have discovered an emerging endocrine phenotype, which can heavily impact on the severity of the syndrome, has been recently associated with the COVID-19 disease.
https://pubmed.ncbi.nlm.nih.gov/32651579/
 
https://link.springer.com/article/10.1007%2Fs12020-021-02734-w
 
https://link.springer.com/article/10.1007%2Fs12020-020-02294-5
 
Currently it is now well-known that the likelihood of individuals falling severely ill or dying from COVID-19 is increases if these individuals are obese, or have certain comorbidities like diabetes mellitus (DM), vitamin D deficiency, and vertebral fractures (VFs).
 
Hence any abnormality in the pituitary gland that may lead to metabolic disorders, impaired immunity, and a host of other conditions will also make the body susceptible to infections. Since such conditions are common in patients with COVID-19 as well, it has been hypothesized that there might be a relationship between COVID-19 and pituitary gland disorders.
 
At the same time, researchers have also observed that COVID-19 causes increased severity of pituitary-related disorders, and even pituitary apoplexy, which is a condition defined as internal bleeding or impaired blood supply in the pituitary gland. https://pubmed.ncbi.nlm.nih.gov/33939057/
 
The Italian study team reviewed this bidirectional relationship between the pituitary gland abnormalities and COVID-19.
 
Typically the pituitary gland releases hormones that regulate and control some of the most important functions of the body like growth, metabolism, energy levels, bone health, mood swings, vision, reproduction, and immunity, to name a few. The inability of the pituitary gland to release one or more of these hormones is known as ‘hypopituitarism.’  Factors responsible for hypopituitarism include traumatic brain injury, pituitary adenomas (tumors), genetic mutations, as well as infiltrative and infectious diseases.
 
The condition of hypopituitarism can lead to severe cases of diabetes mellitus (DM), growth hormone deficiency (GHD), abnormal lipid profile, obesity, arterial hypertension, and immune dysfunctions. Interestingly, similar consequences of COVID-19 have also been reported.
 
The SARS-CoV-2 virus infects the human body by binding to a special class of receptors known as the angiotensin-converting enzyme 2 (ACE2) receptors. These receptors are located in the endothelial linings of most organs like the brain, heart, lungs, kidneys, intestine, liver, and pancreas, among others. The main function of the ACE2 receptors is binding to specific target molecules to maintain the renin-angiotensin system that is crucial for regulating dilation of blood vessels, as well as maintain blood glucose levels, the immune system, and homeostasis.
 
Hence, SARS-CoV-2 binding to these ACE2 receptors facilitates the entry of this virus into all the organs that have these receptors, thus leading to the ability of SARS-CoV-2 to cause widespread damage in the body. Upon entry into the pancreas, for example, SARS-CoV-2 can inhibit ß-cells function, which worsens hyperglycemia and increases the risk for acute diabetic complications.
 
Therefore, the presence of ACE2 receptors in brain tissues may cause invasion into the pituitary gland and lead to pituitary apoplexy. The entry of SARS-CoV-2 into the brain can also cause neurological damage in infected patients, which may account for some of the common neurological complaints of COVID-19 including headaches, confusion, dysgeusia, anosmia, nausea, and vomiting.
 
The condition of hypopituitarism leading to metabolic syndrome has been scientifically linked to higher mortality in COVID-19 patients. In fact, the presence of a single metabolic syndrome component has been observed to double the risk of death by COVID-19. This risk was even higher among patients with DM and hypertension.
 
Interestingly there was also an increased incidence of VFs in COVID-19 patients with hypopituitarism. Hence, patients with DM, obesity, hypertension, and chronic inflammatory disease, are all at an increased risk of poor outcomes and death in COVID-19.
 
Importantly arterial hypertension is a common finding in adults with GHD, which is another consequence of hypopituitarism. Hypopituitarism also causes adrenal insufficiency, a condition that is primarily managed with glucocorticoids and hormonal replacement therapies.
 
It should also be noted that often patients with COVID-19 are treated for prolonged periods with high-dose exogenous glucocorticoids, which is a class of steroids that suppress some activities of the immune system. This treatment approach may result in suppression of the hypothalamic-pituitary–adrenal axis that can lead to adrenal insufficiency.
 
The condition of hypogonadism is another aspect of pituitary insufficiency that predisposes patients, especially males, to COVID-19. Evidence shows that males with hypogonadism were more frequently affected by metabolic syndrome.( Hypogonadism occurs when sex glands called gonads produce little, if any, sex hormones.)
 
Pituitary apoplexy, albeit rare, has also been linked to COVID-19, especially in patients with pituitary adenomas and those who are being treated with anticoagulant therapy. (Pituitary apoplexy is a condition in which the pituitary tumor spontaneously hemorrhages or bleeds). This may be because the pituitary gland becomes overstimulated during an infectious disease, which may increase pituitary blood demand and lead to sudden infarction precipitating acute apoplexy.
 
Significantly, this phenomenon has also been shown in patients suffering from infectious diseases that cause hemorrhagic fevers. Taken together, pituitary apoplexy complicates treatment and management procedures in COVID-19 patients.
 
It has been found that despite the use of steroids in COVID-19 patients, there have been no contraindications for vaccination in such patients. However, those on extensive hormonal therapies need constant monitoring for best results.
 
The COVID-19-Pituitary Gland study findings imply that the pituitary gland acts like a double-edged sword for COVID-19. On one end, hypopituitarism predisposes patients to metabolic disorders like DM, obesity, and VFs, all of which are known risk factors for COVID-19.
 
However on the other hand, COVID-19 may cause direct or indirect damage to the pituitary glands by entering the brain and inducing unfavorable vascular events though evidence on this remains lesser in comparison to that of hypopituitarism. Ultimately, the researchers of the current study conclude that managing patients with hormonal insufficiencies optimally with steroids is likely to improve outcomes in severe COVID-19.
 
For more on SARS-CoV-2 and the Pituitary Gland, keep on logging to Thailand Medical News.

Read Also: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009460/