The Adrenal Cortex, an Underestimated Site of SARS-CoV-2 Infection
| Autor: | Lai Jiang, Bo Xu, Dun-Feng Xu, Wenbin Guan, Xiaoyan Zhu, Yuan Gao, Feng Li, Yan-Fei Mao, Rongrong Ren |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Male adrenal cortex Hydrocortisone Endocrinology Diabetes and Metabolism critically ill patients Physiology lcsh:Diseases of the endocrine glands. Clinical endocrinology Dexamethasone 0302 clinical medicine Endocrinology Vasoconstrictor Agents 030212 general & internal medicine Original Research Aged 80 and over Adrenal cortex Serine Endopeptidases Middle Aged medicine.anatomical_structure Corticosteroid Hormonal therapy Female Angiotensin-Converting Enzyme 2 adrenal insufficiency Zona reticularis hormones hormone substitutes and hormone antagonists medicine.drug severe acute respiratory syndrome coronavirus 2 Adrenal Cortex Diseases Adult medicine.drug_class Critical Illness 03 medical and health sciences coronavirus disease 2019 Zona fasciculata medicine Adrenal insufficiency Humans Aged lcsh:RC648-665 business.industry Therapeutic effect COVID-19 medicine.disease Zona Reticularis COVID-19 Drug Treatment 030104 developmental biology Zona Fasciculata business |
| Zdroj: | Frontiers in Endocrinology Frontiers in Endocrinology, Vol 11 (2021) |
| ISSN: | 1664-2392 |
| Popis: | BackgroundThe majority of the critically ill patients may have critical illness-related corticosteroid insufficiency (CIRCI). The therapeutic effect of dexamethasone may be related to its ability to improve cortical function. Recent study showed that dexamethasone can reduce COVID-19 deaths by up to one third in critically ill patients. The aim of this article is to investigate whether SARS-CoV-2 can attack the adrenal cortex to aggravate the relative adrenal insufficiency.MethodsWe summarized the clinical features of COVID-19 reported in currently available observational studies. ACE2 and TMPRSS2 expression was examined in human adrenal glands by immunohistochemical staining. We retrospectively analyzed serum cortisol levels in critically ill patients with or without COVID-19.ResultsHigh percentage of critically ill patients with SARS-COV-2 infection in the study were treated with vasopressors. ACE2 receptor and TMPRSS2 serine protease were colocalized in adrenocortical cells in zona fasciculata and zona reticularis. We collected plasma cortisol concentrations in nine critically ill patients with COVID-19. The cortisol levels of critically ill patients with COVID-19 were lower than those in non-COVID-19 critically ill group. Six of the nine COVID-19 critically ill patients had random plasma cortisol concentrations below 10 µg/dl, which met the criteria for the diagnosis of CIRCI.ConclusionWe demonstrate that ACE2 and TMPRSS2 are colocalized in adrenocortical cells, and that the cortisol levels are lower in critically ill patients with COVID-19 as compared to those of non-COVID-19 critically ill patients. Based on our findings, we recommend measuring plasma cortisol level to guide hormonal therapy. |
| Databáze: | OpenAIRE |
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