Endocrinol Metab.  2021 Aug;36(4):757-765. 10.3803/EnM.2021.404.

COVID-19 Vaccination for Endocrine Patients: A Position Statement from the Korean Endocrine Society

• Ku CR
• Jung KY
• Ahn CH
• Moon JS
• Lee JH
• Kim EH
• Kwon H
• Kim HK
• Suh S
• Hong S
• Ha J
• Roh E
• Kim JH
• Kim Mk
• the Committee of Clinical Practice Guideline of the Korean Endocrine Society

• KMID: 2519663
• DOI: http://doi.org/10.3803/EnM.2021.404

Abstract

Since the first outbreak of coronavirus disease 2019 (COVID-19), ongoing efforts have been made to discover an efficacious vaccine against COVID-19 to combat the pandemic. In most countries, both mRNA and DNA vaccines have been administered, and their side effects have also been reported. The clinical course of COVID-19 and the effects of vaccination against COVID-19 are both influenced by patients’ health status and involve a systemic physiological response. In view of the systemic function of endocrine hormones, endocrine disorders themselves and the therapeutics used to treat them can influence the outcomes of vaccination for COVID-19. However, there are very limited data to support the development of clinical guidelines for patients with specific medical backgrounds based on large clinical trials. In the current severe circumstances of the COVID-19 pandemic, position statements made by clinical specialists are essential to provide appropriate recommendations based on both medical evidence and clinical experiences. As endocrinologists, we would like to present the medical background of COVID-19 vaccination, as well as precautions to prevent the side effects of COVID-19 vaccination in patients with specific endocrine disorders, including adrenal insufficiency, diabetes mellitus, osteoporosis, autoimmune thyroid disease, hypogonadism, and pituitary disorders.

Keyword

Adrenal insufficiency; Thyroiditis, autoimmune; COVID-19 vaccines; Diabetes mellitus; Osteoporosis; Hypogonadism; Hypopituitarism; Pituitary neoplasms

Reference

1. Rhee EJ, Kim JH, Moon SJ, Lee WY. Encountering COVID-19 as endocrinologists. Endocrinol Metab (Seoul). 2020; 35:197–205.

2. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021; 384:403–16.

3. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine. N Engl J Med. 2020; 383:2603–15.

4. Luger A, Giustina A, Peeters R. European Society of Endocrinology (ESE)’s statement concerning COVID 19 vaccination: ‘follow the same recommendations for patients with stable endocrine disorders as for the general population’ 2021 [Internet]. Bristol: European Society of Endocrinology;2021. [cited 2021 Aug 9]. Available from: https://www.ese-hormones.org/news/ese-news/european-society-of-endocrinology-ese-s-statement-concerning-covid-19-vaccination-follow-the-same-recommendations-for-patients-with-stable-endocrine-disorders-as-for-the-general-population .

5. Katznelson L, Gadelha M. Glucocorticoid use in patients with adrenal insufficiency following administration of the COVID-19 vaccine: a pituitary society statement. Pituitary. 2021; 24:143–5.

6. Puig-Domingo M, Marazuela M, Yildiz BO, Giustina A. COVID-19 and endocrine and metabolic diseases. An updated statement from the European Society of Endocrinology. Endocrine. 2021; 72:301–16.

7. Serban AL, Ferrante E, Carosi G, Indirli R, Arosio M, Mantovani G. COVID-19 in Cushing disease: experience of a single tertiary centre in Lombardy. J Endocrinol Invest. 2021; 44:1335–6.

8. Adir Y, Humbert M, Saliba W. COVID-19 risk and outcomes in adult asthmatic patients treated with biologics or systemic corticosteroids: nationwide real-world evidence. J Allergy Clin Immunol. 2021; 148:361–7.

9. Brenner EJ, Ungaro RC, Gearry RB, Kaplan GG, Kissous-Hunt M, Lewis JD, et al. Corticosteroids, but not TNF antagonists, are associated with adverse COVID-19 outcomes in patients with inflammatory bowel diseases: results from an international registry. Gastroenterology. 2020; 159:481–91.

10. Arlt W, Baldeweg SE, Pearce SHS, Simpson HL. Endocrinology in the time of COVID-19: management of adrenal insufficiency. Eur J Endocrinol. 2020; 183:G25–32.

11. Stewart PM, Biller BM, Marelli C, Gunnarsson C, Ryan MP, Johannsson G. Exploring inpatient hospitalizations and morbidity in patients with adrenal insufficiency. J Clin Endocrinol Metab. 2016; 101:4843–50.

12. Carosi G, Morelli V, Del Sindaco G, Serban AL, Cremaschi A, Frigerio S, et al. Adrenal insufficiency at the time of COVID-19: a retrospective study in patients referring to a tertiary center. J Clin Endocrinol Metab. 2021; 106:e1354–61.

13. Inoue S, Shibata Y, Takabatake N, Igarashi A, Abe S, Kubota I. Influence of corticosteroid therapy on the serum antibody response to influenza vaccine in elderly patients with chronic pulmonary diseases. EXCLI J. 2013; 12:760–5.

14. Chung SM, Lee YY, Ha E, Yoon JS, Won KC, Lee HW, et al. The risk of diabetes on clinical outcomes in patients with coronavirus disease 2019: a retrospective cohort study. Diabetes Metab J. 2020; 44:405–13.

15. Gregory JM, Slaughter JC, Duffus SH, Smith TJ, LeStourgeon LM, Jaser SS, et al. COVID-19 severity is tripled in the diabetes community: a prospective analysis of the pandemic’s impact in type 1 and type 2 diabetes. Diabetes Care. 2021; 44:526–32.

16. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia: a systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr. 2020; 14:395–403.

17. Kim MK, Jeon JH, Kim SW, Moon JS, Cho NH, Han E, et al. The clinical characteristics and outcomes of patients with moderate-to-severe coronavirus disease 2019 infection and diabetes in Daegu, South Korea. Diabetes Metab J. 2020; 44:602–13.

18. Lim S, Bae JH, Kwon HS, Nauck MA. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nat Rev Endocrinol. 2021; 17:11–30.

19. Barron E, Bakhai C, Kar P, Weaver A, Bradley D, Ismail H, et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol. 2020; 8:813–22.

20. Cariou B, Hadjadj S, Wargny M, Pichelin M, Al-Salameh A, Allix I, et al. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 2020; 63:1500–15.

21. Moon SJ, Rhee EJ, Jung JH, Han KD, Kim SR, Lee WY, et al. Independent impact of diabetes on the severity of coronavirus disease 2019 in 5,307 patients in South Korea: a nationwide cohort study. Diabetes Metab J. 2020; 44:737–46.

22. Pal R, Bhadada SK, Misra A. COVID-19 vaccination in patients with diabetes mellitus: current concepts, uncertainties and challenges. Diabetes Metab Syndr. 2021; 15:505–8.

23. World Health Organization. Interim recommendations for use of the AZD1222 (ChAdOx1-S [recombinant]) vaccine against COVID-19 developed by Oxford University and AstraZeneca [Internet]. Geneva: WHO;2021. [cited 2021 Aug 9]. Available from: https://apps.who.int/iris/bitstream/handle/10665/340920/WHO-2019-nCoV-vaccines-SAGE_recommendation-AZD1222-2021.2-eng.pdf?sequence=1&isAllowed=y .

24. Dooling K, Marin M, Wallace M, McClung N, Chamberland M, Lee GM, et al. The advisory committee on immunization practices’ updated interim recommendation for allocation of COVID-19 vaccine: United States, December 2020. MMWR. 2021; 69:1657–60.

25. Central Disaster Management Headquarters. Who first gets the COVID-19 vaccination? [Internet]. Cheongju: Korea Disease Control and Prevention Agency;2021. [cited 2021 Aug 9]. Available from: https://ncv.kdca.go.kr/menu.es?mid=a10117010000 .

26. Diabetes UK. Coronavirus vaccines and diabetes [Internet]. London: Diabetes UK;2021. [cited 2021 Aug 9]. Available from: https://www.diabetes.org.uk/about_us/news/coronavirus-vaccines .

27. European Centre for Disease Prevention and Control. COVID-19 vaccination and prioritisation strategies in the EU/EEA. Stockholm: ECDC;2020.

28. Frasca D, Diaz A, Romero M, Mendez NV, Landin AM, Ryan JG, et al. Young and elderly patients with type 2 diabetes have optimal B cell responses to the seasonal influenza vaccine. Vaccine. 2013; 31:3603–10.

29. Li Volti S, Caruso-Nicoletti M, Biazzo F, Sciacca A, Mandara G, Mancuso M, et al. Hyporesponsiveness to intradermal administration of hepatitis B vaccine in insulin dependent diabetes mellitus. Arch Dis Child. 1998; 78:54–7.

30. Looijmans-Van den Akker I, Verheij TJ, Buskens E, Nichol KL, Rutten GE, Hak E. Clinical effectiveness of first and repeat influenza vaccination in adult and elderly diabetic patients. Diabetes Care. 2006; 29:1771–6.

31. Smith SA, Poland GA. Use of influenza and pneumococcal vaccines in people with diabetes. Diabetes Care. 2000; 23:95–108.

32. American Diabetes Association. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes-2021. Diabetes Care. 2021; 44(Suppl 1):S40–52.

33. Lampasona V, Secchi M, Scavini M, Bazzigaluppi E, Brigatti C, Marzinotto I, et al. Antibody response to multiple antigens of SARS-CoV-2 in patients with diabetes: an observational cohort study. Diabetologia. 2020; 63:2548–58.

34. Kesavadev J, Misra A, Das AK, Saboo B, Basu D, Thomas N, et al. Suggested use of vaccines in diabetes. Indian J Endocrinol Metab. 2012; 16:886–93.

35. Ulivieri FM, Banfi G, Camozzi V, Colao A, Formenti AM, Frara S, et al. Vitamin D in the COVID-19 era: a review with recommendations from a G.I.O.S.E.G. expert panel. Endocrine. 2021; 72:597–603.

36. Zhu FC, Li YH, Guan XH, Hou LH, Wang WJ, Li JX, et al. Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial. Lancet. 2020; 395:1845–54.

37. Fuggle NR, Singer A, Gill C, Patel A, Medeiros A, Mlotek AS, et al. Correction to: how has COVID-19 affected the treatment of osteoporosis? An IOF-NOF-ESCEO global survey. Osteoporos Int. 2021; 32:801.

38. Cummings SR, Ferrari S, Eastell R, Gilchrist N, Jensen JB, McClung M, et al. Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM Trial and its extension. J Bone Miner Res. 2018; 33:190–8.

39. Zanchetta MB, Boailchuk J, Massari F, Silveira F, Bogado C, Zanchetta JR. Significant bone loss after stopping long-term denosumab treatment: a post FREEDOM study. Osteoporos Int. 2018; 29:41–7.

40. Franquemont S, Galvez J. Subacute thyroiditis after mRNA vaccine for COVID-19. J Endocr Soc. 2021; 5(Suppl 1):A956–7.

41. Iremli BG, Sendur SN, Unluturk U. Three cases of subacute thyroiditis following SARS-CoV-2 vaccine: post-vaccination ASIA syndrome. J Clin Endocrinol Metab. 2021; 106:2600–5.

42. Vera-Lastra O, Ordinola Navarro A, Cruz Domiguez MP, Medina G, Sanchez Valadez TI, Jara LJ. Two cases of Graves’ disease following SARS-CoV-2 vaccination: an autoimmune/inflammatory syndrome induced by adjuvants. Thyroid. 2021. May. 3. [Epub]. https://doi.org/10.1089/thy.2021.0142 .

43. Dotan A, Muller S, Kanduc D, David P, Halpert G, Shoenfeld Y. The SARS-CoV-2 as an instrumental trigger of autoimmunity. Autoimmun Rev. 2021; 20:102792.

44. Okpechi SC, Fong JT, Gill SS, Harman JC, Nguyen TH, Chukwurah QC, et al. Global sex disparity of COVID-19: a descriptive review of sex hormones and consideration for the potential therapeutic use of hormone replacement therapy in older adults. Aging Dis. 2021; 12:671–83.

45. Acheampong DO, Barffour IK, Boye A, Aninagyei E, Ocansey S, Morna MT. Male predisposition to severe COVID-19: review of evidence and potential therapeutic prospects. Biomed Pharmacother. 2020; 131:110748.

46. Klein SL, Dhakal S, Ursin RL, Deshpande S, Sandberg K, Mauvais-Jarvis F. Biological sex impacts COVID-19 outcomes. PLoS Pathog. 2020; 16:e1008570.

47. Alkhouli M, Nanjundappa A, Annie F, Bates MC, Bhatt DL. Sex differences in case fatality rate of COVID-19: insights from a multinational registry. Mayo Clin Proc. 2020; 95:1613–20.

48. Qiao Y, Wang XM, Mannan R, Pitchiaya S, Zhang Y, Wotring JW, et al. Targeting transcriptional regulation of SARS-CoV-2 entry factors ACE2 and TMPRSS2. Proc Natl Acad Sci U S A. 2021; 118:e2021450118.

49. Ciaglia E, Vecchione C, Puca AA. COVID-19 infection and circulating ACE2 levels: protective role in women and children. Front Pediatr. 2020; 8:206.

50. Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respir Med. 2020; 8:e20.

51. Montopoli M, Zumerle S, Vettor R, Rugge M, Zorzi M, Catapano CV, et al. Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (N=4532). Ann Oncol. 2020; 31:1040–5.

52. Shimabukuro TT, Cole M, Su JR. Reports of anaphylaxis after receipt of mRNA COVID-19 vaccines in the US-December 14, 2020–January 18, 2021. JAMA. 2021; 325:1101–2.

53. Tresoldi AS, Sumilo D, Perrins M, Toulis KA, Prete A, Reddy N, et al. Increased infection risk in Addison’s disease and congenital adrenal hyperplasia. J Clin Endocrinol Metab. 2020; 105:418–29.