The polycystic ovary syndrome (PCOS) and hyperandrogenism are some of the most common endocrine disorders in women of fertile age. Insulin resistance is present in a significant proportion of hyperandrogenic patients, yet also, impaired beta-cell function, even in absence of clinically evident glucose intolerance, is a frequent finding, especially in patients with familial history of type 2 diabetes mellitus. Therefore, it is not surprising that hyperandrogenism, PCOS, and disorders of carbohydrate metabolism are associated frequently. This association was first reported 75 years ago and, although the mechanisms responsible are not precisely understood, insulin resistance plays an important role in the development of both disorders. PCOS patients develop type 2 diabetes mellitus more frequently than non-hyperandrogenic women and, conversely, women with type 2 diabetes have a greater risk of having PCOS compared with the normal population. Although type 1 diabetes mellitus is a disease characterized by complete abolition of endogenous insulin secretion, a certain degree of hyperinsulinism may exist, resulting from the relatively excessive insulin doses needed to maintain a strict metabolic control. This exogenous hyperinsulinism may increase ovarian androgen secretion, and it has been reported that there is an increased prevalence of hyperandrogenic disorders in type 1 diabetic women. Considering that insulin resistance, hyperinsulinemia and androgen excess may collaborate in increasing the risk for CVD in these women, the identification of hyperandrogenic symptoms in diabetic women, and the identification of disorders of glucose tolerance in hyperandrogenic patients, may have important consequences for the correct management of these women.

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Background: A potential association between use of angiotensin-converting–enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB) and coronavirus disease 2019 (COVID-19) severity has been suggested. We conducted a retrospective study to investigate the association between ACEI/ARB use and COVID-19 severity and mortality. Methods: The first 1,000 consecutive patients with COVID-19 who were attended in the emergency department at the Infanta Sofía University Hospital were included. Clinical data was manually extracted by reviewing medical records, and the ACEI/ARB prescription was assessed from an electronic pharmacy database. The primary endpoints were critical COVID-19 and mortality. Results: A total of 241 (24.1%) patients had a critical COVID-19 and 171 (17.1%) died. ACEI use was associated with critical COVID-19 (OR 1.90, 95% CI 1.34-2.70), and with mortality (OR 1.98, 95% CI 1.35-2.91) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 1.15 95% CI 0.69-1.94, and OR 1.00 95% CI 0.56-1.77, respectively). Similarly, ARB use was associated with critical COVID-19 (OR 1.58, 95% CI 1.11-2.58), although not with mortality (OR 1.47, 95% CI 0.98-2.19) in the unadjusted analysis, but not after adjusting by age, sex and comorbidities (OR 0.97, 95% CI 0.57-1.65, and OR 0.74, 95% CI 0.41-1.33, respectively). Conclusion: These results suggest that the use of ACEI/ARB is not independently associated with COVID-19 severity and mortality.