SAT290 Course of SARS-CoV-2 Infection In Patients With Congenital Adrenal Hyperplasia

• Published in: Journal of the Endocrine Society Vol. 7; no. Supplement_1
• Main Authors: Javaid, Rida, Kollender, Sarah, Moon, Amy, Merke, Deborah P
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 05.10.2023
• Subjects: Adrenal (Excluding Mineralocorticoids)
• ISSN: 2472-1972; 2472-1972
• DOI: 10.1210/jendso/bvad114.294

Abstract Disclosure: R. Javaid: None. S. Kollender: None. A. Moon: None. D.P. Merke: Research Investigator; Self; Diurnal, Neurocrine Biosciences. Patients with primary adrenal insufficiency (PAI) are at risk for life-threatening adrenal crises, most often triggered by illness. Prior studies suggest possible inefficient immune response in PAI, especially in patients with autoimmune Addison’s disease. Starting in December 2019, the pandemic due to the novel SARS-CoV-2 coronavirus created many challenges in patient management. Data regarding COVID-19,risk of severe illness, and proper prevention of adrenal crisis in patients with PAI due to congenital adrenal hyperplasia (CAH) are lacking.Objective:To describe the experience of patients with PAI due to CAH who acquired COVID-19 in a large cohort study.Methods:Questionnaires and retrospective chart reviews were performed for all patients enrolled in a Natural History Study at the National institute of Health (NCT00250159) who reported COVID-19 infection from March 2019 until November 2022.Results:42 patients with CAH (25 salt-wasting 21OHD, 13 simple virilizing 21OHD, 1 nonclassic 21OHD, 3 P450 SCC deficiency) reported 46 episodes of COVID-19 infections (12 pediatric, 34 adult), 16 were before nationwide vaccine distribution. Of the 30 responses post vaccine, 23 were vaccinated and 7 were unvaccinated. Patients were instructed to stress dose according to standard guidelines for general illnesses. In 21 episodes, patients did not stress dose; in 25 episodes, patients stress dosed orally (1 to 15days); in 6 episodes, patients received intramuscular Solucortef injections. Two patients (8 y.o., 63 y.o.) were hospitalized. One patient with salt-wasting CAH and asthma developed long COVID following 2COVID-19 episodes. Patient risk factors for COVID-19 included: 6 obese (BMI > 30), 2 tobacco users, 1 with concomitant type 1 diabetes mellitus. COVID-related symptomatology was similar to national trends. Early in the pandemic, patients were more likely to have loss of taste and smell, as well as GI symptoms, and later in the pandemic, patients were more likely to experience cough, sore throat, tiredness, and body aches. Data analysis underway.Conclusion:Patients with PAI due to CAH do not appear to be at greater risk of acquiring COVID-19 and do not have higher risk of complications triggered by COVID-19 infection than the general population. Standard glucocorticoid stress dosing guidelines are appropriate in the setting of COVID-19. Glucocorticoid stress dosing is not recommended if the patient is without fever or gastrointestinal symptoms. Presentation: Saturday, June 17, 2023