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Erschienen in: Endocrine 2/2020

24.06.2020 | COVID-19 | Letter to the Editor Zur Zeit gratis

Consideration on TMPRSS2 and the risk of COVID-19 infection in Cushing’s syndrome

verfasst von: Mattia Barbot, Filippo Ceccato, Carla Scaroni

Erschienen in: Endocrine | Ausgabe 2/2020

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Excerpt

Patients with Cushing’s syndrome (CS) have an increased susceptibility to infections that contribute to their higher mortality. Cortisol excess reduces B-cell development and proliferation, T helper 1 lymphocyte response, and induces neutrophilia with an increase in neutrophil/lymphocyte (N/L) ratio in a concentration-dependent manner [ 1]. These changes are associated with more severe, protracted clinical course, and disseminated forms of common viral infections such as influenza and likely also to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the high mortality of untreated CS, a rapid surgical approach to the cause of the hormonal excess is the first-tier option. In the current pandemic scenario, access to surgical procedure have been necessarily restrained, as most of our affords have been shifted to handle COVID-19 patients. Moreover, hospitalization and surgical stress are associated with changes in immune profile that can further exacerbate immunodepression in CS patients. Alternative therapies based on cortisol-lowering medications, usually considered second-line option after surgical failure, can actually allow to reschedule the intervention. Commercially available steroidogenesis inhibitors, such as ketoconazole and metyrapone, have several advantages due to the convenient way of administration, rapid onset of action and their possible use in all type of CS. Furthermore, they act on androgens secretion which has recently become of interest in SARS-COV-2 infection; androgen action has been pointed out as a potential contributor to the higher prevalence of COVID-19 among men and their worse outcome compared to female [ 2]. A possible explanation to this gender-related difference is connected to the expression of transmembrane protease serine 2 (TMPRSS2) in bronchial epithelium whose expression is finely regulated by androgen signaling. TMPRSS2, firstly studied in prostate cancer, was indeed found as essential to activate the spikes, induce viral spread, and pathogenesis in the infected hosts [ 3]. …
Literatur
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Metadaten
Titel
Consideration on TMPRSS2 and the risk of COVID-19 infection in Cushing’s syndrome
verfasst von
Mattia Barbot
Filippo Ceccato
Carla Scaroni
Publikationsdatum
24.06.2020
Verlag
Springer US
Schlagwort
COVID-19
Erschienen in
Endocrine / Ausgabe 2/2020
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-020-02390-6