Outcome of COVID-19 infections in patients with adrenal insufficiency and excess

• Published in: Endocrine Connections Vol. 12; no. 4; pp. 1 - 9
• Main Authors: Nowotny, Hanna F., Bryce, Jillian, Ali, Salma R, Giordano, Roberta, Baronio, Federico, Chifu, Irina, Tschaidse, Lea, Cools, Martine, Van den Akker, Erica L T, Falhammar, Henrik, Appelman-Dijkstra, Natasha M., Persani, Luca, Beccuti, Guglielmo, Ross, Ian L, Grozinsky-Glasberg, Simona, Pereira, Alberto M, Husebye, Eystein S, Hahner, Stephanie, Ahmed, S. Faisal, Reisch, Nicole
• Format: Journal Article
• Language: English
• Published: England Bioscientifica Ltd 01.04.2023; Bioscientifica
• Subjects: adrenal insufficiency; cushing’s syndrome; glucocorticoids; sars-cov-2; SARS-CoV-2; adrenal insufficiency; Cushing’s syndrome; glucocorticoids
• ISSN: 2049-3614; 2049-3614
• DOI: 10.1530/EC-22-0416

Background: Information on clinical outcome of coronavirus disease 19 (COVID-19) infection in patients with adrenal disorders is scarce. Methods: A collaboration between the ESE Rare Disease Committee and ENDO-ERN via the European Registries for Rare Endocrine Conditions (EuRRECa) allowed the collection of data of 64 cases (57 adrenal insufficiency (AI), 7 Cushing’s syndrome) that had been reported by 12 centres in 8 European between January 2020 and December 2021. Results: Of all 64 patients, 23 were males and 41 females (13 of those children) with a median age of 37 and 51 years. In 45/57 (95%) AI cases, COVID-19 infection was confirmed by testing. Primary insufficiency was present in 45/57 patients; 19 were affected by Addison’s disease (AD), 19 by congenital adrenal hyperplasia, 7 by PAI due to other causes. Most relevant comorbidities were hypertension (12%), obesity (n = 14%) and diabetes mellitus (9%). An increase by a median of 2.0 (IQR 1.4) times the daily replacement dose was reported in 42 (74%) patients. Two patients administered i.m. injection of 100 mg hydrocortisone, 11/64 were admitted to hospital. Two patients had to be transferred to the intensive care unit, one with lethal outcome. Four patients reported persistent SARS-CoV-2 infection, all others complete remission. Conclusion: This European multicentric questionnaire is the first to collect data on the outcome of COVID-19 infection in patients with adrenal gland disorders. It suggests good clinical outcome in case of duly dose adjustments and emphasizes the importance of patient education on sick day rules.