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121
SARS-CoV-1 and the adrenal glands
At autopsy in patients with SARS, ACE2 receptor expression and the presence
of SARS-CoV-1 RNA in the adrenal glands were found, degeneration and necrosis of
cortical cells was detected due to the direct cytopathic effect of the virus or
vasculitis/thrombosis of adrenal vessels. However, to date, there are no clinical
studies demonstrating primary adrenal insufficiency associated with SARS-CoV-1.
SARS-CoV-2 and adrenal glands
Zinserling VA et al. (2020), in an autopsy study of 10 patients who died from
COVID-19, described two types of adrenal lesions. The first is the infiltration by
immune cells (CD3+ and CD8+) of various layers of the cortex and surrounding
tissue. The second was characterized by the presence of small groups of proliferating
cells with enlarged light nuclei. These changes were similar to those seen in the lungs
and were thought to be a direct effect of SARS-CoV-2. Therefore, patients with
COVID-19 may be characterized by primary adrenal insufficiency due to both direct
viral damage to adrenal cells and inflammatory/autoimmune processes in these
organs. Freire Santana et al. (2020) at autopsy in 12 of 28 patients (46 %) with
COVID, microscopic lesions of the adrenal glands were found: ischemic necrosis,
cortical lipid degeneration, bleeding, nonspecific focal adrenalitis, vascular
thrombosis, foci of inflammation. However, further studies will be required to prove
the presence of SARS-CoV-2 in adrenal tissue and definitively determine the
mechanisms of degeneration and loss of function. Iuga A. C. et al. (2020) in five
patients who died from COVID-19, they found preferential damage to the vessels of
the adrenal glands, and not to other organs. Microscopic examination showed acute
fibrinoid necrosis of the adrenal cortex and medulla arterioles with subendothelial
vacuolization, without any significant inflammation, adrenal parenchymal infarcts, or
thrombosis. It is unclear whether adrenal vasculopathy is caused by hypoxia, a
systemic immune response, a direct cytopathic effect of the virus, or a combination of
events.
Finally, two cases of bilateral acute adrenal hemorrhage in patients with
COVID-19 have been described in the literature. In both cases, the presence of an
underlying autoimmune disease on the background of COVID-19 may predispose to
the development of hemostasis disorders, disseminated intravascular coagulation,
thrombosis with subsequent bleeding in the most vascularized organs, such as
endocrine glands.
122
Coronaviruses and ovaries
There is some evidence of ovarian susceptibility to SARS-CoV-1 and SARSCoV-2 infections due to ACE2 receptor expression in these organs.
SARS-CoV-1 and the ovaries
There is little evidence for SARS-CoV-1 infection in the ovaries.
Immunohistochemical and in situ hybridization studies failed to detect SARS-CoV-1
RNA polymerase in the ovaries of four patients who died of SARS.
SARS-CoV-2 and the ovaries
There is no evidence of SARS-CoV-2 ovarian involvement. Therefore, further
research is needed to determine the impact of COVID-19 on the ovaries and female fertility.
Coronaviruses and testicles
The expression of the ACE2 receptor in testicular cells is very high, and
therefore it is reasonable to assume that these organs can be infected with both
SARS-Cov-1 and SARS-CoV-2.
SARS-CoV-1 and testicles
A series of autopsy studies have shown that orchitis is a complication of SARS.
However, there are conflicting data on the presence of SARS-CoV-1 RNA in testis cells.
SARS-CoV-2 and testicles
Yang M, et al. in 11 patients with COVID-19 aged 42 to 87 years (mean age
65 years), with an average duration of the disease (from onset to death) of 42 days
(from 23 to 75 days), microscopic examination revealed different degrees of
vacuolization and rarefaction of the cytoplasm Sertoli cells, a decrease in the number
of Leydig cells in the testes, infiltrates of T-lymphocytes and histiocytes were present
in the interstitium. SARS-CoV-2 virus particles in the testicles were found in only
one patient. Achua J. K. et al. (2020) autopsy confirmed lymphocytic and
macrophage infiltration along with normal spermatogenesis in 5 0% of cases.
Moreover, Li H. et al. (2020) examining the testicles and epididymis found interstitial
edema, congestion, exudation of erythrocytes in the testes/epudendi, and thinning of
123
the seminiferous tubules with elevated concentrations of CD3+ and CD68+ in the
interstitium. The high number of apoptotic cells in the seminiferous tubules and the
presence of IgG suggest impaired spermatogenesis in patients with COVID-19.
Sperm evaluation of 23 patients with COVID-19 showed that 39.1 % (n = 9) had
oligozoospermia and 60.9 % (n =14) had a high white blood cell count. Also, an
increased level of IL-6, TNF-a and MCP-1 was found in the semen compared to the
control. All semen samples were negative for SARS-CoV-2 RNA, and the patients
had no history of infertility or steroid treatment. These results are comparable to
those obtained in patients with SARS-CoV-1. Interestingly, a study involving
81 male COVID-19 patients and 100 healthy sex-matched and age-matched controls
demonstrated a significant increase in serum LH, while testosterone (T)/LH and
FSH/LH ratios dropped dramatically. Moreover, testosterone levels did not differ
significantly between the groups. An elevated serum LH level and a decreased T/LH
ratio are clinical signs of primary hypogonadism, suggesting testicular damage and
Leydig cell involvement. However, the long-term effects of COVID-19 on the
testicles are still not known. The possibility of recurrence of the virus, the
transmission of an infectious agent with seminal fluid, the impact on fertility and
cryopreservation are assumed. Pan F. et al. (2020), did not detect SARS-CoV-2 in
semen collected from 34 COVID-19 patients with mild or moderate symptoms
between 8 and 75 days (median 31 days) after COVID-19 diagnosis, despite that
19 % of them complained of discomfort in the scrotum at the time of diagnosis of
COVID-19. According to this Song data C. et al. (2020) found SARS-CoV-2 RNA in
the semen of 12 asymptomatic/mild COVID-19 patients between days 14 and 42 after
COVID-19 diagnosis. Moreover, the authors failed to detect COVID-19 RNA in
testicular tissues of the deceased.
To date, there is only one study of Li D. et al. (2020) was able to detect the
virus in 6 of 38 semen samples collected from both acute and convalescent patients
with COVID-19. This finding contrasts with previous studies and should be
interpreted with caution. First, this study was conducted in a specialized COVID-19
hospital where the most severe cases were admitted. Consequently, a more severe
course of the disease is accompanied by a higher titer of the virus in the blood and a
higher probability of spread to other organs and tissues, including semen. In
particular, the blood-testis barrier is permeable to viruses, especially in the case of
systemic inflammation and viremia. Moreover, in a specialized hospital for COVID19, there is a high possibility of spreading the virus in the environment, and false
positive results may be obtained due to respiratory droplets. Thus, the available
conflicting data, due to the urgency of the problem, indicate the need for further
research on larger cohorts of infected people.
124
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TEST TASKS
Variant 1
1. Somatopause is:
a) age-related decrease in the secretion of growth hormone
b) age-related decrease in TTH secretion
c) age-related decrease in ACTH secretion
2. IGF-1 level with age:
a) goes up
b) is decreasing
c) does not change
3. blood cortisol levels with age:
a) goes up
b) is decreasing
c) does not change
4. activity of 11-β-hydroxysteroid dehydrogenase type 1 with age:
a) goes up
b) is decreasing
c) does not change
5. blood DHEA levels with age:
a) goes up
b) is decreasing
c) does not change
6. The relationship between DHEA levels and the following diseases has been proven
a) Alzheimer's disease
b) type 2 diabetes
c) depression
d) pyelonephritis
130
7. cortisol/DHEA ratios with age:
a) goes up
b) is decreasing
c) does not change
8) Basal secretion of adrenaline with age:
a) goes up
b) is decreasing
c) does not change
9. The level of LH and FSH in the blood of women with age:
a) goes up
b) is decreasing
c) does not change
10. blood TTH level with age:
a) goes up
b) is decreasing
c) does not change
Sample answers
1 — A
2 —B
3 — A
4 —A
5 — B
6 —
A B C
7 — B
8 — B
9 — A
10 —A
Variant 2
1. Immunity of a person to the development of infection is provided by:
a) low dose of the pathogen
b) weak virulence of the pathogen
c) the absence of receptors in the tissues of the macroorganism for the ligands of the
pathogen
d) activation of the compliment system
e) activation of the interferon system
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