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      Hypocortisolism in survivors of severe acute respiratory syndrome (SARS)

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          Summary

          Objective  Following the severe acute respiratory syndrome (SARS) outbreak, many survivors were observed to suffer from psychosomatic symptoms reminiscent of various endocrine disorders. Hence, we sought to determine the existence of any chronic endocrine sequelae in SARS survivors.

          Design, patients, measurements  Sixty‐one survivors of SARS prospectively recruited were analysed for hormonal derangements 3 months following recovery. Patients with pre‐existing endocrine disorders were excluded. Any endocrine abnormalities diagnosed were investigated and treated where indicated up to a year. Serial evaluation facilitated characterization of trends and prognostication of any endocrinological aberrations.

          Results  Twenty‐four (39·3%) patients had evidence of hypocortisolism. The hypothalamic–pituitary–adrenal (HPA) axis dysfunction of the majority resolved within a year. Two (3·3%) of the hypocortisolic cohort had transient subclinical thyrotoxicosis. Four (6·7%) were biochemically hypothyroid, being comprised of three with central hypothyroidism and one with primary hypothyroidism. Two of the three with central hypothyroidism had concomitant central hypocortisolism. Eight had subnormal DHEAS levels.

          Conclusions  These preliminary findings highlight a possible aetiologic role of SARS‐associated coronavirus in causing a reversible hypophysitis or direct hypothalamic effect, with the HPA axis affected more frequently than the HPT axis.

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          Most cited references25

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          CD209L (L-SIGN) is a receptor for severe acute respiratory syndrome coronavirus.

          Angiotensin-converting enzyme 2 (ACE2) is a receptor for SARS-CoV, the novel coronavirus that causes severe acute respiratory syndrome [Li, W. Moore, M. J., Vasilieva, N., Sui, J., Wong, S. K., Berne, M. A., Somasundaran, M., Sullivan, J. L., Luzuriaga, K., Greenough, T. C., et al. (2003) Nature 426, 450-454]. We have identified a different human cellular glycoprotein that can serve as an alternative receptor for SARS-CoV. A human lung cDNA library in vesicular stomatitis virus G pseudotyped retrovirus was transduced into Chinese hamster ovary cells, and the cells were sorted for binding of soluble SARS-CoV spike (S) glycoproteins, S(590) and S(1180). Clones of transduced cells that bound SARS-CoV S glycoprotein were inoculated with SARS-CoV, and increases in subgenomic viral RNA from 1-16 h or more were detected by multiplex RT-PCR in four cloned cell lines. Sequencing of the human lung cDNA inserts showed that each of the cloned cell lines contained cDNA that encoded human CD209L, a C-type lectin (also called L-SIGN). When the cDNA encoding CD209L from clone 2.27 was cloned and transfected into Chinese hamster ovary cells, the cells expressed human CD209L glycoprotein and became susceptible to infection with SARS-CoV. Immunohistochemistry showed that CD209L is expressed in human lung in type II alveolar cells and endothelial cells, both potential targets for SARS-CoV. Several other enveloped viruses including Ebola and Sindbis also use CD209L as a portal of entry, and HIV and hepatitis C virus can bind to CD209L on cell membranes but do not use it to mediate virus entry. Our data suggest that the large S glycoprotein of SARS-CoV may use both ACE2 and CD209L in virus infection and pathogenesis.
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            Severe acute respiratory syndrome (SARS)—paradigm of an emerging viral infection ☆

            An acute and often severe respiratory illness emerged in southern China in late 2002 and rapidly spread to different areas of the Far East as well as several countries around the globe. When the outbreak of this apparently novel infectious disease termed severe acute respiratory syndrome (SARS) came to an end in July 2003, it had caused over 8000 probable cases worldwide and more than 700 deaths. Starting in March 2003, the World Health Organization (WHO) organised an unprecedented international effort by leading laboratories working together to find the causative agent. Little more than one week later, three research groups from this WHO-coordinated network simultaneously found evidence of a hitherto unknown coronavirus in SARS patients, using different approaches. After Koch’s postulates had been fulfilled, WHO officially declared on 16 April 2003 that this virus never before seen in humans is the cause of SARS. Ever since, progress around SARS-associated coronavirus (SARS-CoV) has been swift. Within weeks of the first isolate being obtained, its complete genome was sequenced. Diagnostic tests based on the detection of SARS-CoV RNA were developed and made available freely and widely; nevertheless the SARS case definition still remains based on clinical and epidemiological criteria. The agent’s environmental stability, methods suitable for inactivation and disinfection, and potential antiviral compounds have been studied, and development of vaccines and immunotherapeutics is ongoing. Despite its grave consequences in humanitarian, political and economic terms, SARS may serve as an example of how much can be achieved through a well-coordinated international approach, combining the latest technological advances of molecular virology with more “traditional” techniques carried out to an excellent standard.
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              Psychoneuroendocrinological contributions to the etiology of depression, posttraumatic stress disorder, and stress-related bodily disorders: the role of the hypothalamus–pituitary–adrenal axis

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                Author and article information

                Journal
                Clin Endocrinol (Oxf)
                Clin. Endocrinol. (Oxf)
                10.1111/(ISSN)1365-2265
                CEN
                Clinical Endocrinology
                Blackwell Science Ltd (Oxford, UK )
                0300-0664
                1365-2265
                05 July 2005
                August 2005
                : 63
                : 2 ( doiID: 10.1111/cen.2005.63.issue-2 )
                : 197-202
                Affiliations
                [ 1 ]Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital,
                [ 2 ]Department of Psychological Medicine, Tan Tock Seng Hospital,
                [ 3 ]Department of Respiratory Medicine, Tan Tock Seng Hospital,
                [ 4 ]Department of Diagnostic Radiology, Tan Tock Seng Hospital, and
                [ 5 ]Department of Infectious Diseases, Communicable Disease Centre, Singapore
                Author notes
                [*] [* ]Melvin Khee‐Shing Leow, Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. Tel.: (65) 6‐256‐6011; Fax: (65) 6‐357‐7871; E‐mail: mleowsj@ 123456massmed.org
                Article
                CEN2325
                10.1111/j.1365-2265.2005.02325.x
                7188349
                16060914
                f315fd6e-819e-4dc8-ab26-44061a7a78f7

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 3 February 2005
                : 19 April 2005
                : 7 June 2005
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 26, Pages: 6, Words: 3632
                Categories
                Original Articles
                Custom metadata
                2.0
                August 2005
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:15.04.2020

                Endocrinology & Diabetes
                Endocrinology & Diabetes

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