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Relação entre vacinas anti-Sars-CoV-2/COVID longa e o sistema endócrino : scoping review
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Desde o final de 2020, diversas vacinas contra a COVID-19 foram introduzidas no mercado, tendo sido reportados, entre outros, efeitos adversos do foro endócrino, como tiroidite subaguda ou emergências hiperglicémicas. Por outro lado, passaram a ser reportados casos de indivíduos com sintomas persistentes de COVID aguda, quadro sindromático designado de “Síndrome Pós-COVID” ou “COVID longa”. Nestes casos, foi colocada a suspeita da possibilidade de envolvimento endócrino.
Com vista a analisar estudos primários que estudaram a associação entre as vacinas COVID/COVID longa e o sistema endócrino, foi realizada uma scoping review, tendo a pesquisa sido efetuada nas bases de dados Pubmed e Web of Science. Dos 230 artigos inicialmente identificados, 56 foram incluídos na análise final: 49 artigos sobre a temática das vacinas COVID - 37 estudos descritivos (casos clínicos e séries de casos) e 12 estudos analíticos (1 experimental, 11 observacionais) – e 7 artigos referentes à COVID longa - 3 casos clínicos, 1 estudo de coorte e 3 estudos transversais. De modo geral, nos artigos sobre a vacinação COVID, a patologia tiroideia foi a mais reportada nos casos clínicos, enquanto as alterações na função e/ou autoimunidade tiroideia foram as mais avaliadas nos estudos analíticos. Relativamente à COVID longa, os casos clínicos abordaram sobretudo alterações relacionadas com os eixos hipotálamo-hipófise-gónadas e suprarrenais; os estudos analíticos também mostraram preponderância na análise de alterações na função e/ou autoimunidade tiroideias.
Esta revisão revelou que a maioria da literatura destes temas consiste em estudos descritivos, com baixo nível de evidência. Relativamente às vacinas COVID, os efeitos adversos endócrinos foram de modo geral ligeiros, com tratamento semelhante às patologias não associadas à vacinação e com uma evolução favorável. Os estudos analíticos, em termos gerais, não mostraram risco aumentado de alterações endócrinas associadas com a vacinação, mas nos casos em que elas surgiram, a tendência foi de serem ligeiras e autolimitadas. A temática da COVID longa apresenta evidência escassa, mas os estudos apontam para alguma sobreposição entre sintomatologia de patologias endócrinas e de COVID longa.
Since the end of 2020, several COVID-19 vaccines have been introduced on the market, and endo-crine adverse effects such as subacute thyroiditis or hyperglycemic emergencies have been report-ed, among others. On the other hand, cases of individuals with persistent symptoms of acute COVID, a syndrome called "Post-COVID Syndrome" or "Long COVID", were reported. In these cas-es, the possibility of endocrine involvement was also suspected. To analyze primary studies that studied the association between COVID-19 vaccines/Long COVID and the endocrine system, a scoping review was conducted, with the search being conducted in the Pubmed and Web of Science databases. Of the 230 articles initially identified, 56 were included in the final analysis: 49 articles on COVID-19 vaccines - 37 descriptive studies (clinical cases and case series) and 12 analytical studies (1 experimental, 11 observational) - and 7 articles on long COVID - 3 clinical cases, 1 cohort study and 3 cross-sectional studies. Overall, in the articles on COVID vaccination, thyroid pathology was the most reported in the clinical cases while the changes in thyroid function and/or autoimmunity were the most evaluated in the analytical studies. Re-garding long COVID, clinical cases mainly addressed changes related to the hypothalamic-pituitary-gonadal and adrenal axes; analytical studies also showed a preponderance in the analysis of changes in thyroid function and/or autoimmunity. This review revealed that most of the literature on these topics consists of descriptive studies, with a low level of evidence. Regarding COVID vaccines, endocrine adverse effects were generally mild, with treatment similar to pathologies not associated with vaccination and with a favorable evolu-tion. The analytical studies, in general terms, showed no increased risk of endocrine alterations associated with vaccination, however, when it happened their course was mild and self-limiting. There is scarce evidence about long COVID, but the studies indicate some overlap between symp-toms of endocrine pathologies and long COVID.
Since the end of 2020, several COVID-19 vaccines have been introduced on the market, and endo-crine adverse effects such as subacute thyroiditis or hyperglycemic emergencies have been report-ed, among others. On the other hand, cases of individuals with persistent symptoms of acute COVID, a syndrome called "Post-COVID Syndrome" or "Long COVID", were reported. In these cas-es, the possibility of endocrine involvement was also suspected. To analyze primary studies that studied the association between COVID-19 vaccines/Long COVID and the endocrine system, a scoping review was conducted, with the search being conducted in the Pubmed and Web of Science databases. Of the 230 articles initially identified, 56 were included in the final analysis: 49 articles on COVID-19 vaccines - 37 descriptive studies (clinical cases and case series) and 12 analytical studies (1 experimental, 11 observational) - and 7 articles on long COVID - 3 clinical cases, 1 cohort study and 3 cross-sectional studies. Overall, in the articles on COVID vaccination, thyroid pathology was the most reported in the clinical cases while the changes in thyroid function and/or autoimmunity were the most evaluated in the analytical studies. Re-garding long COVID, clinical cases mainly addressed changes related to the hypothalamic-pituitary-gonadal and adrenal axes; analytical studies also showed a preponderance in the analysis of changes in thyroid function and/or autoimmunity. This review revealed that most of the literature on these topics consists of descriptive studies, with a low level of evidence. Regarding COVID vaccines, endocrine adverse effects were generally mild, with treatment similar to pathologies not associated with vaccination and with a favorable evolu-tion. The analytical studies, in general terms, showed no increased risk of endocrine alterations associated with vaccination, however, when it happened their course was mild and self-limiting. There is scarce evidence about long COVID, but the studies indicate some overlap between symp-toms of endocrine pathologies and long COVID.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
SARS-CoV-2 Vacinas COVID longo Endocrinopatias Tiroide Endocrinologia