Acute and chronic endocrine abnormalities during and after COVID-19 infection in children and adolescents: A mini review

Background: The COVID-19 pandemic has resulted in widespread disruptions across multiple physiological systems in children and adolescents, including the endocrine system. Emerging global data reveal both acute and chronic endocrine abnormalities linked to SARS-CoV-2 infection and its systemic inflammatory response.

Objective: To review and compare the prevalence and mechanisms of endocrine dysfunctions in pediatric populations during and following COVID-19, based on real, validated international studies from 2019 to 2025.

Methods: A systematic literature review was conducted across PubMed, Embase, Medline, and Google Scholar between 2019 and 2025. Inclusion criteria included peer-reviewed studies involving pediatric COVID-19 cases and endocrine complications. Data from 41 validated studies were synthesized. A PRISMA diagram was used to track study selection. Descriptive statistics and pooled prevalence were used to compare acute and chronic outcomes, and the methodological quality of studies was assessed using Cochrane and Newcastle–Ottawa criteria.

Results: Acute endocrine complications included non-thyroidal illness syndrome (NTIS) (33–88%), HPA axis suppression, adrenal crisis (3.4%), subacute thyroiditis, and transient glycemic disturbances. Chronic complications included a 2–3× rise in central precocious puberty, significant increases in new-onset type 1 diabetes with diabetic ketoacidosis (DKA) in up to 51%, and rising rates of pediatric obesity and metabolic syndrome. These conditions showed variation by age, sex, and geography. Mechanistically, endocrine dysfunctions were driven by direct viral invasion (via ACE2), cytokine storm, autoimmune activation, iatrogenic steroid use, lifestyle disruption, and RAAS imbalance.

Conclusion: COVID-19 poses both direct and indirect risks to endocrine health in pediatric populations. Heightened awareness, age- and sex-specific monitoring, and regionally tailored endocrine follow-up protocols are essential to reduce long-term morbidity.