ESPE Abstracts

Introduction: There is limited data on endocrine manifestations of the COVID-19 pandemic in children/adolescents. We conducted a scoping review to summarize available evidence.

Method: A literature search was conducted using PubMed, Scopus and Google Scholar databases to identify studies on endocrine manifestations of COVID-19 in children/adolescents, published up to 31/03/2023 using pre-specified keywords, and perusing additional references from relevant articles. Evidence is presented for obesity/insulin resistance, puberty, thyroid disorders, adrenal disorders and pituitary disorders.

Results: A total of 38 studies were reviewed including 2,061,942 subjects, including data on obesity/insulin resistance (n=2,058,876), puberty (n=1868), thyroid dysfunction (n=352), and adrenal disorders (n=846). A rise in obesity following the pandemic, was reported in many studies (pre-pandemic 10.4%-36.2% vs post-pandemic 12.3%-45.7%), with boys being more affected, together with an increase in incidence of type 2 diabetes in one study (annualized incidence 17.6 vs 48) with younger age of onset (12.9 vs 14.8 years). Associated factors included lockdown restrictions, reduced physical activity, increased screen time, dysregulated sleep patterns, unhealthy diet and stress. Seven studies reported an increased incidence of central precocious puberty(CPP) (range pre-pandemic 1.4%-26% vs 5.0%-46.8% post-pandemic), predominantly among girls, as well as an accelerated rate of pubertal progression. Reasons postulated include disturbances in hypothalamic-pituitary-gonadal axis due to sleep disturbances, restricted outdoor activities, increased screen time, binge eating and high-calorie intake during the lockdown. While long-term thyroid dysfunction rates remained stable during the pandemic, an increase in mild transient thyroid dysfunction was reported. Further, worsening of thyroiditis and Graves’ disease were not reported among children. However, low free triiodothyronine (fT3) levels were associated with development of multisystem inflammatory syndrome (MIS-C) and need for intensive care among children with COVID-19 infection. Children with pre-existing adrenal insufficiency showed higher rates of sepsis, need for intubation and mortality when infected with SARS-CoV-2. There were no reports of children developing pituitary apoplexy following COVID-19 or of children with pre-existing hypopituitarism being at increased risk of severe COVID-19 infection.

Conclusion: The COVID-19 pandemic was associated with an increase in overweight/obesity among children/adolescents, especially boys, and an increase in rate and progression of CPP, especially among girls, possibly due to lifestyle changes imposed by lockdown/restrictions during the pandemic. Significant effects of the COVID-19 pandemic on long-term thyroid, adrenal and pituitary dysfunction were not found. Among children with COVID-19 infection, low fT3 levels and pre-existing adrenal insufficiency were associated with severe disease/complications.