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Management of Patients With Glucocorticoid-Related Diseases and COVID-19
Frontiers in Endocrinology ( IF 5.2 ) Pub Date : 2021-09-14 , DOI: 10.3389/fendo.2021.705214
Irina Chifu 1 , Mario Detomas 1 , Ulrich Dischinger 1 , Otilia Kimpel 1 , Felix Megerle 1 , Stefanie Hahner 1 , Martin Fassnacht 1, 2, 3 , Barbara Altieri 1
Affiliation  

The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a global health crisis affecting millions of people worldwide. SARS-CoV-2 enters the host cells by binding to angiotensin-converting enzyme 2 (ACE2) after being cleaved by the transmembrane protease serine 2 (TMPRSS2). In addition to the lung, gastrointestinal tract and kidney, ACE2 is also extensively expressed in endocrine tissues, including the pituitary and adrenal glands. Although glucocorticoids could play a central role as immunosuppressants during the cytokine storm, they can have both stimulating and inhibitory effects on immune response, depending on the timing of their administration and their circulating levels. Patients with adrenal insufficiency (AI) or Cushing’s syndrome (CS) are therefore vulnerable groups in relation to COVID-19. Additionally, patients with adrenocortical carcinoma (ACC) could also be more vulnerable to COVID-19 due to the immunosuppressive state caused by the cancer itself, by secreted glucocorticoids, and by anticancer treatments. This review comprehensively summarizes the current literature on susceptibility to and outcome of COVID-19 in AI, CS and ACC patients and emphasizes potential pathophysiological mechanisms of susceptibility to COVID-19 as well as the management of these patients in case of SARS-CoV-2. Finally, by performing an in silico analysis, we describe the mRNA expression of ACE2, TMPRSS2 and the genes encoding their co-receptors CTSB, CTSL and FURIN in normal adrenal and adrenocortical tumors (both adenomas and carcinomas).



中文翻译:

糖皮质激素相关疾病和 COVID-19 患者的管理

由严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 感染引起的 2019 年冠状病毒病 (COVID-19) 大流行是一场全球健康危机,影响了全世界数百万人。SARS-CoV-2 被跨膜蛋白酶丝氨酸 2 (TMPRSS2) 切割后,通过与血管紧张素转换酶 2 (ACE2) 结合进入宿主细胞。除了肺、胃肠道和肾脏,ACE2 还在内分泌组织中广泛表达,包括垂体和肾上腺。尽管糖皮质激素可以在细胞因子风暴期间作为免疫抑制剂发挥核心作用,但它们可以对免疫反应产生刺激和抑制作用,这取决于它们的给药时间和循环水平。因此,肾上腺功能不全 (AI) 或库欣综合征 (CS) 的患者是 COVID-19 的弱势群体。此外,由于癌症本身、分泌的糖皮质激素和抗癌治疗引起的免疫抑制状态,肾上腺皮质癌 (ACC) 患者也可能更容易感染 COVID-19。本综述全面总结了当前关于 AI、CS 和 ACC 患者对 COVID-19 的易感性和结果的文献,并强调了对 COVID-19 易感性的潜在病理生理机制以及这些患者在 SARS-CoV-2 情况下的管理. 最后,通过执行 由于癌症本身、分泌的糖皮质激素和抗癌治疗引起的免疫抑制状态,肾上腺皮质癌 (ACC) 患者也可能更容易感染 COVID-19。本综述全面总结了当前关于 AI、CS 和 ACC 患者对 COVID-19 的易感性和结果的文献,并强调了对 COVID-19 易感性的潜在病理生理机制以及这些患者在 SARS-CoV-2 情况下的管理. 最后,通过执行 由于癌症本身、分泌的糖皮质激素和抗癌治疗引起的免疫抑制状态,肾上腺皮质癌 (ACC) 患者也可能更容易感染 COVID-19。本综述全面总结了当前关于 AI、CS 和 ACC 患者对 COVID-19 的易感性和结果的文献,并强调了对 COVID-19 易感性的潜在病理生理机制以及这些患者在 SARS-CoV-2 情况下的管理. 最后,通过执行 CS 和 ACC 患者,并强调对 COVID-19 易感性的潜在病理生理机制以及在 SARS-CoV-2 情况下对这些患者的管理。最后,通过执行 CS 和 ACC 患者,并强调对 COVID-19 易感性的潜在病理生理机制以及在 SARS-CoV-2 情况下对这些患者的管理。最后,通过执行电脑模拟 分析,我们描述了 ACE2、TMPRSS2 以及编码它们共同受体的基因 CTSB, CTSL福林 在正常肾上腺和肾上腺皮质肿瘤(腺瘤和癌)中。

更新日期:2021-09-14
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