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

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.

SARS-CoV-2 Infection Alters the Phenotype and Gene Expression of Adipocytes

“…WAT has been implicated as a target for SARS-CoV-2 and a potential reservoir for prolonged viral shedding, suggesting a potential contribution to the outcome of "long COVID". Notably, SARS-CoV-2 has been detected in postmortem specimens of white adipose tissue from infected subjects [10][11][12].…”