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. 2024 Jan;83(1):110-117.
doi: 10.1007/s12020-023-03518-0. Epub 2023 Sep 12.

SARS-CoV-2 spread to endocrine organs is associated with obesity: an autopsy study of COVID-19 cases

Anello Marcello Poma  1 , Alessio Basolo  2 , Greta Alì  1 , Diana Bonuccelli  3 , Iosè Di Stefano  1 , Marco Conti  3 , Paola Mazzetti  4 , Rebecca Sparavelli  1 , Paola Vignali  1 , Elisabetta Macerola  1 , Mauro Pistello  4 , Ferruccio Santini  2 , Fulvio Basolo  5 , Antonio Toniolo  6
Affiliations

SARS-CoV-2 spread to endocrine organs is associated with obesity: an autopsy study of COVID-19 cases

Anello Marcello Poma et al. Endocrine. 2024 Jan.

Abstract

Purpose: SARS-CoV-2 infection may be limited to the respiratory tract or may spread to multiple organs. Besides disease severity, factors associated with virus spread within the host are elusive. Here, we tried to identify features associated with SARS-CoV-2 spread to endocrine organs.

Methods: In a retrospective autoptic cohort of 51 subjects who died because of COVID-19, we analyzed the severity and type of lung pathology, patients' features and the detection of virus in thyroid, testis, adrenal gland, pancreas, anterior pituitary, and the white adipose tissue (WAT).

Results: The SARS-CoV-2 genome was detected in endocrine organs of 30/51 cases. The anterior pituitary and WAT were most frequently positive for virus. While pathological features of lung were not associated with the presence of virus in endocrine organs, obesity (BMI > 30) was significantly associated to virus detection in pancreas (p = 0.01) and thyroid (p = 0.04). WAT infection was detected more frequently in males (p = 0.03).

Conclusion: In subject with obesity dying of COVID-19, the virus frequently spreads to endocrine organs. The findings emphasize the need for optimal treatment of patients with obesity at the very onset of COVID-19. Since post-COVID conditions remain a major issue worldwide, a rigorous follow-up of endocrine function-especially of thyroid and pancreas-is advocated in subjects with obesity.

Keywords: COVID-19; Endocrine; Obesity; SARS-CoV-2.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Histologic features of lung parenchyma in severe COVID-19. Hematoxylin and eosin staining: A a case with hyaline membranes and type 2 cell hyperplasia (original magnification ×10); B fibrin thrombus in an arteriole (×10); C acute inflammation of lung parenchyma characterized by neutrophil infiltration and alveolar wall injury (×10); D lymphocytic infiltration in chronic inflammation (×10); E young collagen with features of organizing pneumonia (×10); F high power magnification of an enlarged pneumocyte with intracytoplasmic inclusions (black arrow, ×60)
Fig. 2
Fig. 2
Summary of virus detection and other parameters in endocrine organs. Left side: the heatmap shows detection (orange) or absence (blue) of SARS-CoV-2 genome in the investigated tissues. Not tested tissues are in gray. Each row refers to its case number on the left. Each column represents an endocrine organ. Center: for each case, sidebars show age category (adult or elderly), sex, BMI class, vaccination status. Right side: horizontal lines represent time from the onset of symptoms to death. Blank rows: data not available. Color codes for each parameter are shown on the right
Fig. 3
Fig. 3
Detection of SARS-CoV-2 in the investigated endocrine organs. A Concordance among detection of SARS-CoV-2 genome in endocrine organs was assessed by Cohen’s kappa (k) coefficient with 1 denoting perfect concordance. B Virus detection in different organs according to age class. C Virus detection in subjects without or with obesity. D Virus detection according to sex. E Virus detection according to vaccination state. Differences were compared using the Fisher’s exact test. Asterisks indicate statistical significance
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