Critical Care Endocrinology – Part II
In this article we continue the multinational interview with experts from around the globe on the topic of Critical Care Endocrinology.
What is the interplay between adrenal health and critical care? What adrenal disorders do you commonly see in critical care settings? How can Endocrinology help improve critical care delivery?
Syed Abbas Raza, Pakistan
The COVID-19 pandemic has surprised us in many ways and it continues to baffle the world including health care providers. Along with other unexpected challenges, it has a number of endocrine repercussions that healthcare professionals hardly saw coming.
Adrenal hormones play a pivotal role in critical care setting. Also, people with adrenal insufficiency or uncontrolled Cushing’s syndrome have blunted immune response. These individuals hence face a greater risk of infection especially respiratory-related infection, including COVID-19.
Acute clinical situations may expose a person’s underlying poor adrenal response / reserve (adrenal insufficiency) or ability to fight infection in sub clinical Cushing’s syndrome.
In acute illness it is difficult to assess endocrine disorders, which include variations in thyroid, adrenal and other hormonal axis. Having an endocrinologist on board may help in early detection and appropriate management of these disorders. Simple measures, like instruction to adjust hydrocortisone dose as play a pivotal role in avoiding dreadful complication of adrenal crisis.
Does Vitamin D play a role in the natural history and survival of critical illness?
Hasan Aydin, Turkey
Yes, I believe and observe in my clinical practice. The prevalence of vitamin D deficiency ranges from 40-70%. There are studies reporting an association between vitamin D deficiency and poor outcomes, both morbidity and mortality. Duration of admission in ICU and the duration of mechanical ventilation are longer in deficient patients.
Also, some preliminary studies report a possible benefit of high dose vitamin D replacement in patients with critical illness. Although most of them report limited or no benefit on morbidity or mortality, larger studies required. Also, megadoses used in these studies carry risk of hypercalcemia and increased fracture risk.
In summary, vitamin D deficiency plays an important role in critical care, but replacement may have limited benefit.
What changes will COVID19 bring about in endocrinology?
Zhanay Akanov, Kazakhstan
In Kazakhstan today, more than 70-80% of all medical consultations are related to COVID-19. We have “forgotten” oncology, cardiovascular disease, diabetes mellitus, tuberculosis and other infections. In Kazakhstan, fortunately, we do not have a lot of persons with uncontrolled diabetes, at high risk of acute complications. However, if we will continue to think only about coronavirus and do not restart diabetes education (stopped from end of March) then we will have this problem soon.
At the same time, patients are now afraid to come to hospitals. They feel that the risk of contracting COVID-19 is more in hospitals in the street or home. In spite of medical or surgical problems, they prefer to wait till lockdown is over. This increases the chances of complications, and increases the risk of need for ICU care: this is the paradox we face.
Our message to the public should be: Please, do not panic, return to ordinary life, while practicing personal and social hygiene. To fellow endocrinologists: we should remember that we have to manage not only COVI-19, but all other diseases, just like in pre-pandemic times. And we must be ready to help to all types of our patients!
Please share some best practices related to Critical Care Endocrinology from your country
KVS Hari Kumar, India
Critical Care Endocrinology was the focus of Endocrine Society of India (ESI) during the COVID pandemic. ESI organized a series of webinars on the topic for the benefit of COVID caregivers and also conducted an “Ideathon” competition among the members for giving suggestions to mitigate the pandemic. The top-rated ideas were submitted to the public health authorities for further action. All the ESI members, including the Yuvacrinology brigade have offered their services to the needy patients through digital media seamlessly. You can find our webinars on the ISE Global Education Hub.