Implications of Dysnatremia and Endocrine Disturbances in COVID-19 Patients

Zlosa, Mihaela; Grubišić, Barbara; Švitek, Luka; Sabadi, Dario; Canecki-Varžić, Silvija; Mihaljević, Ivica; Bilić-Ćurčić, Ines; Kizivat, Tomislav

doi:10.3390/ijms25189856

Open AccessReview

Implications of Dysnatremia and Endocrine Disturbances in COVID-19 Patients

by

Mihaela Zlosa

^1,2

,

Barbara Grubišić

^1,2,

Luka Švitek

^1,3

,

Dario Sabadi

^1,3,4

,

Silvija Canecki-Varžić

^5,6,

Ivica Mihaljević

^7,8,9,

Ines Bilić-Ćurčić

^5,10,*

and

Tomislav Kizivat

^7,8

¹

Clinic for Infectious Diseases, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia

²

Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia

³

Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia

⁴

Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 21 Crkvena Street, HR-31000 Osijek, Croatia

⁵

Department of Endocrinology, Internal Medicine Clinic, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia

⁶

Department of Pathophysiology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia

⁷

Clinical Institute of Nuclear Medicine and Radiation Protection, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia

⁸

Department for Nuclear Medicine and Oncology, Faculty of Medicine, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia

⁹

Academy of Medical Sciences of Croatia, 15 Kaptol Street, HR-10000 Zagreb, Croatia

¹⁰

Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia

^*

Author to whom correspondence should be addressed.

Int. J. Mol. Sci. 2024, 25(18), 9856; https://doi.org/10.3390/ijms25189856

Submission received: 30 June 2024 / Revised: 5 September 2024 / Accepted: 11 September 2024 / Published: 12 September 2024

(This article belongs to the Special Issue Advances in Molecular Biology of Pituitary Diseases)

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Abstract

Sodium imbalance is a common electrolyte disturbance in COVID-19, often linked to disruptions in hormonal regulation. This review explores the relationship between sodium dysregulation and endocrine disturbances, particularly focusing on primary and secondary hypothyroidism, hypocortisolism, and the renin–angiotensin–aldosterone system (RAAS). Hypocortisolism in COVID-19, due to adrenal insufficiency or secondary to pituitary dysfunction, can lead to hyponatremia through inadequate cortisol levels, which impair renal free water excretion and enhance antidiuretic hormone (ADH) secretion. Similarly, hypothyroidism is associated with decreased renal blood flow and the glomerular filtration rate (GFR), which also increases ADH activity, leading to water retention and dilutional hyponatremia. Furthermore, COVID-19 can disrupt RAAS (primarily through its interaction with the angiotensin-converting enzyme 2 (ACE2) receptor), diminishing aldosterone secretion and further contributing to sodium loss and hyponatremia. These hormonal disruptions suggest that sodium imbalance in COVID-19 is multifactorial and warrants further investigation into the complex interplay between COVID-19, endocrine function, and sodium homeostasis. Future research should focus on understanding these mechanisms to develop management algorithms that address both sodium imbalance and underlying hormonal disturbances in order to improve prognosis and outcomes in COVID-19 patients.

Keywords: COVID-19; sodium imbalance; inappropriate ADH syndrome; pituitary gland; adrenal gland; thyroid gland; prognosis

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MDPI and ACS Style

Zlosa, M.; Grubišić, B.; Švitek, L.; Sabadi, D.; Canecki-Varžić, S.; Mihaljević, I.; Bilić-Ćurčić, I.; Kizivat, T. Implications of Dysnatremia and Endocrine Disturbances in COVID-19 Patients. Int. J. Mol. Sci. 2024, 25, 9856. https://doi.org/10.3390/ijms25189856

AMA Style

Zlosa M, Grubišić B, Švitek L, Sabadi D, Canecki-Varžić S, Mihaljević I, Bilić-Ćurčić I, Kizivat T. Implications of Dysnatremia and Endocrine Disturbances in COVID-19 Patients. International Journal of Molecular Sciences. 2024; 25(18):9856. https://doi.org/10.3390/ijms25189856

Chicago/Turabian Style

Zlosa, Mihaela, Barbara Grubišić, Luka Švitek, Dario Sabadi, Silvija Canecki-Varžić, Ivica Mihaljević, Ines Bilić-Ćurčić, and Tomislav Kizivat. 2024. "Implications of Dysnatremia and Endocrine Disturbances in COVID-19 Patients" International Journal of Molecular Sciences 25, no. 18: 9856. https://doi.org/10.3390/ijms25189856

APA Style

Zlosa, M., Grubišić, B., Švitek, L., Sabadi, D., Canecki-Varžić, S., Mihaljević, I., Bilić-Ćurčić, I., & Kizivat, T. (2024). Implications of Dysnatremia and Endocrine Disturbances in COVID-19 Patients. International Journal of Molecular Sciences, 25(18), 9856. https://doi.org/10.3390/ijms25189856

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Implications of Dysnatremia and Endocrine Disturbances in COVID-19 Patients

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