[OA] Covid-19: The challenges facing endocrinology.
The Covid-19 pandemic has hit the planet like a tidal wave, imperiling the lives of thousands and threatening health systems with collapse. In this issue of the Annals of Endocrinology, Alexandre et al. [1] remind us that the gateway to Sars-CoV-2 is the angiotensin II converting enzyme (ACE2), physiological regulator of the renin-angiotensin system (RAS).
Angiotensin II stimulates the secretion of aldosterone via the AT1 receptor of the adrenal gland (glomerulated zone) and has its own vasoconstrictive, pro-fibrosing, pro-inflammatory activity. ACE2 converts angiotensin II-[1–8] to angiotensin-[1–7], which has properties opposite to those of angiotensin II, and is therefore a negative regulator of the RAS.
The legitimate question raised by the authors is whether the prescription of converting enzyme inhibitor [1–10] (ACEi) and angiotensin receptor type 1 blockers (ARAII), very widely used in hypertension treatment, may increase the risk of developing severe acute respiratory syndrome in Covid-19-infected patients.
It is convincingly explained why, on the basis of the available evidence, scientific societies do not recommend discontinuation of hypertension treatment by ACEi and ARAIIs in Covid-19+ patients. Therapeutic prospects and the first trials of the use of the soluble form of ACE2 as a virus trap are underway.
Covid-19 challenges the endocrinologist in many ways. Three in particular are worth raising here:
· the relative protection of children, presumed to be healthy carriers, and the lower incidence of death in women (1/3) suggest that the hormonal environment and genetic aspects are factors for surviving Covid-19. We know for example that the TLR7 gene present on the X chromosome is a receptor which influences antiviral response [2]. Paradoxically, as immune response is stronger in women, contributing to greater susceptibility to autoimmune disease, this flaw becomes an advantage over viral infection. In men, who make up more than two-thirds of deaths from Covid-19, risk is higher after 50 years and even more after 70 years. But age is not the only factor; a context of metabolic syndrome with overweight, diabetes and hypertension seems to be strongly associated with this risk. It is important to remember that the decline in testosterone secretion in humans can be explained by 4 factors: age, obesity, associated comorbidities, and smoking [3]. Strangely, the ACE2 protein is expressed in many tissues, including the testicle [4]. These avenues could be explored to better identify the influence of sex hormones on the ability to resist viral disease;
· a cytokine storm is reported during the respiratory distress phase in 20% of Covid-19 + patients with multi-organ failure and hypotension refractory to standard treatment [5]. How does the adrenal cortex function react in this critical situation? Is there an analogy with what has been well described in septic shock? [6]. We already know that corticosteroids are not useful in the treatment of pulmonary lesions associated with severe respiratory distress, and are indeed deleterious by delaying elimination of the virus. Is there any form of resistance to glucocorticoids?
· the Covid-19 epidemic has served as an opportunity to adopt teleconsultation to respond to the urgent need for continuity of care. This is bound to lead to reimagining a definitive shift to telemedicine in the management of chronic diseases, which is liable to disrupt our practice and teaching and also the entire economic system of health-care.
In this issue of the Annals, a current update on the relationships of diabetes, but also obesity, with the risk of contracting Covid-19 or developing a severe form is presented. This didactic article by Laura Orioli et al. [8], documented by a literature in full effervescence would be very useful for the informed reader or the general practitioner and will enable him to follow the future recommendations to treat the Covid+ diabetic patients.
Endocrinologists and diabetologists, like many other specialists, must prepare for this very immediate deadline.
The reader will find the answers to the questions posed by aging, which is the center of attention of the whole medical community, in the management of thyroid diseases. This consensus statement, coordinated by Philippe Caron, is remarkable, practical and exhaustive. It is based on the extensive clinical experience of its authors.
Pugeat M, Chabre O, Van Tyghem M-C. Covid-19: The challenges facing endocrinology. Annales d'Endocrinologie 2020;81:61-2. Covid-19: The challenges facing endocrinology - ScienceDirect
i saw it north of that location, near the New Hampshire border. (If I in fact saw the monkey) wonder if it has covid?
