Thalassemia and COVID-19: Susceptibility and Severity

Context: COVID-19 results in an imbalance between procoagulant and anticoagulant homeostatic mechanisms that could be complicated with thrombotic events. In β-thalassemia patients, the presence of comorbidities, iron overload, adrenal hypofunction, splenectomy, and chronic hypercoagulable state might increase the susceptibility to COVID-19 and its severity. Evidence Acquisition: The search was conducted in PubMed, Web of Science, and Scopus databases for the key terms of β-thalassemia/thalassemia and COVID-19 until July 2021. Results: The survey of published observational studies (mostly multicenter and case reports) indicated a lower prevalence of COVID-19 in β-thalassemia patients compared with the general population, as well as mild to moderate COVID-19 in these patients, especially in those without comorbidity. β-Thalassemia children were susceptible to COVID-19 but with less severity compared to adults. There is no report of pulmonary embolism and thrombotic events in β-thalassemia patients with COVID-19; however, coagulation abnormality and pulmonary microembolism have been found in these patients. Conclusions: Findings could be interpreted by the presence of high hemoglobin F (HbF) levels, the advantage of hydroxyurea (HU) therapy, splenectomy, and iron chelation therapy in these patients. However, due to the low sample size and studying mainly young patients, the results should be interpreted with caution, and it still needs more studies with a larger sample size to confirm these findings.

PHARMACOLOGICAL FEATURES OF MEDICINAL PRODUCTS WITH MINERALCORTICOID ACTIVITY IN NEPHROLOGICAL PRACTICE

Introduction. Mineralocorticoids mainly affect the exchange of electrolytes, promote retention in the body of sodium, chlorides and water, and accelerate the excretion of potassium, calcium and magnesium. Their synthesis and blood supply are regulated mainly by angiotensin-II, which makes it possible to consider aldosterone as a part of renin-angiotensin-aldosteon system, which ensures the proper state of water-salt metabolism and hemodynamics. The purpose. Consider the relationship of dynamic balance of mineralocorticoids in patients with kidney and adrenal lesions. Material and methods. Review of contemporary and foreign literary sources; techniques - description, analysis, abstracting. Results. The pathogenesis of the development and progression of adrenal and kidney damage is closely associated with impaired synthesis, absorption of mineralocorticoids. The glucocorticoid activity of aldosterone roughly corresponds to 1/3 of cortisone. Main target organs of the hormone are salivary glands and kidneys. In the kidneys, aldosterone enhances sodium reabsorption. In pathological cases, the prolonged presence of chlorides and water in the body leads to the development of edema, hypernatremia, hypokalemia, hypervolemia, arterial hypertension, and sometimes, to the development of congestive heart failure. It poses particular danger in patients with impaired renal function. Deoxycorticosterone acetate (DOCSA) is a synthetic analogue of the Mineralocorticoids of the adrenal cortex. The drug is indicated for rapid-flowing adrenal hypofunction (addisonism), for myasthenia (increases muscle tone and performance), shock and trauma, for hypocorticism. Spironolactone is effective in swelling associated with increased aldosterone production, congestive heart failure, liver cirrhosis and nephrotic syndrome. Conclusions. Patients with kidney and adrenal lesions may have a violation of mineralocorticoid homeostasis, for the correction of which synthetic mineralocorticoids and their analogues, mineral and glucocorticoid antagonists, are used.

Non-functioning pituitary adenomas: clinical feature, laboratorial and imaging assessment, therapeutic management and outcome

OBJECTIVE: This study is an updated review of a Southeast Brazilian experience NFPA, emphasizing clinical features, laboratorial and imaging assessment, therapeutic management and outcome. DESIGN AND METHODS: Retrospective study, in which 104 patients with NFPA were evaluated by the same team of endocrinologists and neurosurgeon. Patients underwent biochemical evaluation, radiological studies and visual field assessment. RESULTS: Hypopituitarism and neuro-ophthalmological defects were observed in 89%. We observed GH deficiency (81.4%), hypogonadism (63.3%), adrenal hypofunction (59.5%), hypothyroidism (20.4%), high (38.5%) and low (16.7%) prolactin levels. Preoperative imaging classified 93% of the tumors as macroadenomas. Extra-sellar expansion was observed in 83.8%. Varying degrees of visual disturbance were observed in 74%. Primary treatment was transsphenoidal surgery (75%). Clinical control was achieved with one surgery in 37.5 % of patients. The majority of patients needed a second therapeutic approach, radiotherapy or other surgeries. Immunohistochemistry resulted negative for pituitary hormones in 43%. Improvement of neuro-ophthalmological symptoms was observed in 61% of the patients after treatment. CONCLUSIONS: Our data confirm elevated prevalence of mass effect and hypopituitarism in patients harboring NFPA. Recurrence due to invasion or incomplete resection of the tumor is quite common, which frequently leads to a second therapeutic option.