COVID-19 Yoğun Bakım Ünitesinde Endokrin Hastalıklara Yaklaşım
Özet
SARS-CoV-2 enfeksiyonunun yoğun bakım ünitesindeki endokrin hastalıklar üzerindeki çift yönlü ve karmaşık etkilerini inceleyen bu çalışma, virüsün ACE2 ve TMPRSS2 reseptörlerini barındıran pankreas, tiroid, böbrek üstü bezleri ve gonadlar gibi dokuları doğrudan enfekte ederek veya sitokin fırtınasıyla indirek hasar oluşturarak klinik yönetimi zorlaştırdığını göstermektedir. Özellikle diyabet, obezite ve adrenal işlev bozukluğu olan hastalarda mortalite ve mekanik ventilasyon ihtiyacı belirgin şekilde artmaktadır. Diyabetli veya hastanede yeni başlangıçlı hiperglisemi gelişen kritik COVID-19 hastalarında sıkı glisemik kontrolün sağlanması, insülin dozajının dinamik yönetimi, gerekirse Sürekli Glikoz İzlemi (CGM) kullanımı ve laktik asidoz riski taşıyan metformin ile ketoasidozu tetikleyebilen SGLT-2 inhibitörleri gibi oral antidiyabetiklerin durdurulması hayati önem taşımaktadır. Cushing sendromu, primer adrenal yetmezlik, tiroid fırtınası riski taşıyan hipertiroidi ve paratiroid bozuklukları olan hastalarda ise enfeksiyon seyrinde sıvı-elektrolit dengesinin korunması, stres dozu steroid uygulamaları ve ilaç etkileşimlerinin dikkatle izlenmesi klinik gidişatı doğrudan etkilemektedir.
SARS-CoV-2 infection on the endocrine system in the intensive care unit shows that the virus complicates clinical management by directly infecting tissues with ACE2 and TMPRSS2 receptors—such as the pancreas, thyroid, adrenal glands, and gonads—or causing indirect damage via cytokine storms. Particularly in patients with diabetes, obesity, and adrenal dysfunction, mortality and mechanical ventilation requirements significantly increase. In critically ill COVID-19 patients with diabetes or new-onset hyperglycemia, maintaining glycemic control, dynamically adjusting insulin doses, utilizing Continuous Glucose Monitoring (CGM) when appropriate, and discontinuing oral antidiabetics like metformin (due to lactic acidosis risk) and SGLT-2 inhibitors (due to ketoacidosis risk) are critical. Furthermore, in patients with Cushing's syndrome, primary adrenal insufficiency, hyperthyroidism with thyroid storm risk, or parathyroid disorders, maintaining fluid-electrolyte balance, applying stress-dose steroid protocols, and closely monitoring drug interactions directly affect clinical outcomes.
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