Endocrine Abstracts

Introduction: Polycystic ovary syndrome (PCOS) affects 5-10% of reproductive aged women. PCOS also manifests a chronic pro-inflammatory state. Estradiol is known to modulate the actions of immune cells, and, therefore, the antiviral mechanisms of these cells could also be modified by this hormone stimulus. In the presence of vitamin D, the binding energy of the spike protein to ACE2 was increased and transferring Apo to Locked S conformer of spike trimer was facilitated. Together, the interaction between spike protein and ACE2 can be disrupted by vitamin D. Potential use of estradiol and vitamin D to reduce virus invasion and replication needs clinical investigation.

Aim: To evaluate the relation between vitamin D and estrogen in PCOS women affected by COVID-19 infection.

Methods: A cohort observational study was conducted. Of the total of 283 PCOS women, 129 affected by COVID-19 infection between March 1, 2021. to June 30, 2022. Ninety-two of them were included in the study. Inclusion criteria were no supplementation with Vitamin D and estrogen, and SARS-CoV-2 test positive. The control group involved 59 PCOS patients not affected by COVID-19. Serum 25-hydroxyvitamin D (vitamin D), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lipid profile, fasting serum glucose, basal insulin, homeostasis model analysis of insulin resistance index (HOMA-IR), TSH, PRl, FSH, LH, 17β-estradiol, and total testosterone were determined. The main outcome were Vitamin D and estradiol levels in PCOS patients with COVID-19 infection compared to women without COVID-19 infection, categorized into mild, moderate, or severe infection according to WHO classification.

Results: After adjusting for age, BMI, insulin resistance and smoking status we found an association between low estradiol and vitamin D, and risks for COVID-19 adverse outcomes. In the fully adjusted model, PCOS women with low vitamin D and low estradiol had a 22% increased risk of COVID-19 (HR: 1.25 (1.05-1.46), P= 0.01).

In conclusion: It is tempting to hypothesize that the synergy between vitamin D and sex hormones could contribute to the COVID-19 outcome in PCOS patients.

Keywords: COVID-19, polycystic ovary syndrome, estradiol, vitamin D