No abstract

SH is associated with the risk of incident CVEs. Besides the clinical follow-up, in patients with an AI >2.4 cm, a long-term biochemical follow-up is also required because of the risk of SH development.

Context COVID-19 represents a global health emergency and infected patients with chronic diseases often present with a severe impairment. Adrenal insufficiency (AI) is supposed to be associated with an increased infection risk which could trigger an adrenal crisis. Objective Our primary aim was to evaluate the incidence of COVID-19 symptoms and complications in AI patients. Design and setting We conducted a retrospective case-control study. All patients were on active follow-up and lived in Lombardy, one of the most affected areas. Patients We enrolled 279 patients with primary and secondary AI and 112 controls (patients with benign pituitary lesions without hormonal alterations). All AI patients had been previously trained to modify their replacement therapy on stress doses. Intervention By administering a standardized questionnaire by phone, we collected data on COVID-19 suggestive symptoms and consequences. Results In February-April 2020, the prevalence of symptomatic patients (complaining at least one symptom of viral infection) was similar between the two groups (24% in AI and 22.3% in controls, p 0.79). Highly suggestive COVID-19 symptoms (at least two including fever and/or cough) also occurred equally in AI and controls (12.5% in both groups). No patient required hospitalization and no adrenal crisis was reported. Few nasopharyngeal swabs were performed (n=12) as indicated by sanitary regulations, limiting conclusions on the exact infection rate (two positive results in AI and none in controls, p 0.52). Conclusions AI patients who are adequately treated and trained, seem to display the same incidence of COVID-19 suggestive symptoms and disease severity as controls.

Background and aim: Hypogonadism frequently occurs in men with type 2 diabetes mellitus (T2DM), while the role of glycemic control and visceral obesity is still unclear. This study aimed to assess the Leydig cell function, including the new sensitive marker insulin-like factor 3 (INSL3), in T2DM patients without overt hypogonadism and the influence of either glycemic control or visceral adiposity. Subjects and methods: Thirty T2DM patients (age 57.1G6.2 years, body mass index (BMI) 28.0G4.3) without overt hypogonadism and 30 age-and BMI-matched controls were studied. Anthropometric, glycometabolic parameters and testosterone, SHBG, LH, INSL3 levels, bioavailable and free testosterone (BT and cFT) were evaluated. The human chorionic gonadotrophin (hCG) test was also performed. Results: Patients had lower total testosterone (452.6G130.0 vs 512.6G117.3 ng/dl, PZ0.06), BT (189.7G36.4 vs 237.1G94.1 ng/dl, PZ0.002), cFT (8.1G1.6 vs 10.1G4.0 ng/dl, PZ0.002), and higher LH levels (3.5G1.6 vs 2.6G1.2 mU/ml, PZ0.01) versus controls. Serum INSL3 concentrations were also lower in patients (1.1G0.3 vs 1.5G0.7 ng/ml, PZ0.01). These hormonal parameters, including INSL3, did not differ between T2DM patients with poor or good glycemic control (HbA1cO9 or !7% respectively). In patients, waist circumferences (97.9G12.4 cm) negatively correlated with INSL3 (PZ0.03) and basal, as well as hCG-stimulated testosterone levels (PZ0.04 and 0.004 respectively). Basal or stimulated hormonal levels and INSL3 concentrations were not different between patients with (40%) or without erectile dysfunction. Conclusions: An early impairment of the overall Leydig cell function is present in men with T2DM, mainly related to visceral adiposity rather than to glycemic control.

Adrenal insufficiency at the time of COVID-19: a retrospective study in patients referring to a tertiary centre.