open access

Vol 72, No 3 (2021)
Review paper
Submitted: 2021-02-13
Accepted: 2021-02-15
Published online: 2021-05-05
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Endocrine and metabolic aspects of COVID-19

Marek Pawlikowski1, Katarzyna Winczyk2
·
Pubmed: 34010445
·
Endokrynol Pol 2021;72(3):256-260.
Affiliations
  1. Professor emeritus, Department of Immunoendocrinology, Medical University of Lodz, Lodz, Poland
  2. Department of Neuroendocrinology, Medical University of Lodz, Lodz, Poland

open access

Vol 72, No 3 (2021)
Review Article
Submitted: 2021-02-13
Accepted: 2021-02-15
Published online: 2021-05-05

Abstract

The paper presents the theoretical considerations on the role of endocrine and metabolic alterations accompanying COVID-19 infection. These alterations may be presumed on the basis of the following two observations. Firstly, the virus SARS-CoV-2 responsible for the COVID-19 infection uses an important renin–angiotensin system (RAS) element — angiotensin-converting enzyme 2 (ACE2) — as a receptor protein for entry into target cells and, in consequence, disturbs the function of the main (circulating) renin–angiotensin–aldosterone system (RAAS) and of the local renin–angiotensin system localized in different tissues and organs. The binding of SARS-CoV-2 to ACE2 leads to the downregulation of this enzyme and, in the aftermath, to the excess of angiotensin II and aldosterone. Thus, in the later stage
of COVID-19 infection, the beneficial effects of ACEI and ARB could be presumed. It is hypothesized that the local RAS dysregulation in the adipose tissue is the main cause of the negative role of obesity as a risk factor of severe outcome of the COVID-19 infection. Secondly, the outcome of COVID-19 strongly depends on the age of the patient. Age-related hormonal deficiencies, especially those of melatonin and dehydroepiandrosterone, may contribute to morbidity/mortality in older people. The usefulness of melatonin and angiotensin converting enzyme inhibitors/angiotensin receptor 1 blockers (the latter only in later phases of the infection) as adjuvant drugs is probable but needs thorough clinical trials. 

Abstract

The paper presents the theoretical considerations on the role of endocrine and metabolic alterations accompanying COVID-19 infection. These alterations may be presumed on the basis of the following two observations. Firstly, the virus SARS-CoV-2 responsible for the COVID-19 infection uses an important renin–angiotensin system (RAS) element — angiotensin-converting enzyme 2 (ACE2) — as a receptor protein for entry into target cells and, in consequence, disturbs the function of the main (circulating) renin–angiotensin–aldosterone system (RAAS) and of the local renin–angiotensin system localized in different tissues and organs. The binding of SARS-CoV-2 to ACE2 leads to the downregulation of this enzyme and, in the aftermath, to the excess of angiotensin II and aldosterone. Thus, in the later stage
of COVID-19 infection, the beneficial effects of ACEI and ARB could be presumed. It is hypothesized that the local RAS dysregulation in the adipose tissue is the main cause of the negative role of obesity as a risk factor of severe outcome of the COVID-19 infection. Secondly, the outcome of COVID-19 strongly depends on the age of the patient. Age-related hormonal deficiencies, especially those of melatonin and dehydroepiandrosterone, may contribute to morbidity/mortality in older people. The usefulness of melatonin and angiotensin converting enzyme inhibitors/angiotensin receptor 1 blockers (the latter only in later phases of the infection) as adjuvant drugs is probable but needs thorough clinical trials. 

Get Citation

Keywords

SARS-CoV-2; COVID-19; renin–angiotensin–aldosterone system; local renin–angiotensin systems; obesity, aging; melatonin; dehydroepiandrosterone

About this article
Title

Endocrine and metabolic aspects of COVID-19

Journal

Endokrynologia Polska

Issue

Vol 72, No 3 (2021)

Article type

Review paper

Pages

256-260

Published online

2021-05-05

Page views

1785

Article views/downloads

1057

DOI

10.5603/EP.a2021.0023

Pubmed

34010445

Bibliographic record

Endokrynol Pol 2021;72(3):256-260.

Keywords

SARS-CoV-2
COVID-19
renin–angiotensin–aldosterone system
local renin–angiotensin systems
obesity
aging
melatonin
dehydroepiandrosterone

Authors

Marek Pawlikowski
Katarzyna Winczyk

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