Endocrine Disorders and COVID-19 Severity in Pediatric Populations: A Systematic Review.

Abstract

The COVID-19 pandemic has significantly impacted global health systems, with emerging evidence suggesting unique implications for pediatric populations with endocrine disorders. While children generally experience milder acute COVID-19 symptoms, those with pre-existing endocrine conditions may face heightened risks due to the interplay between viral infection and endocrine homeostasis. This systematic review aimed to synthesize evidence on the relationship between endocrine disorders and COVID-19 severity in children, focusing on disease outcomes, metabolic control, and management challenges during the pandemic. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library. Ten studies meeting the inclusion criteria were selected after screening 638 records. Data were extracted on study characteristics, patient demographics, endocrine disorders, COVID-19 severity outcomes, and key findings. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) tool. A narrative synthesis was performed due to heterogeneity in study designs and outcomes. The review revealed significant pandemic-related disruptions in pediatric endocrine health, including increased central precocious puberty cases and elevated BMI z-scores in children with obesity. Diabetes outcomes were mixed: type 1 diabetes patients had better mortality prognoses than type 2 diabetes patients, but diabetic ketoacidosis rates surged. Thyroid dysfunction and stable medication adherence in congenital adrenal hyperplasia were also noted. Risk of bias varied, with three studies rated low, five rated moderate, and two rated as high risk of bias. COVID-19 exacerbated endocrine disorders in children through direct viral effects and indirect lifestyle and healthcare disruptions. The findings underscore the need for adaptive care strategies, including telehealth and mental health support, to mitigate long-term impacts. Future research should prioritize prospective studies to evaluate sustained effects and interventions for at-risk populations.