Adrenal Insufficiency at the Time of COVID-19: A Retrospective Study in Patients Referring to a Tertiary Center

Abstract

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.

COVID-19 and the pituitary

“…In a retrospective study with telephone interviews on 279 patients with primary or secondary adrenal insufficiency referring to an Italian tertiary centre [128] no significant differences in prevalence of symptoms suggestive for SARS-CoV-2 in patients vs. controls (24 and 22.3%, respectively) were reported without differences between primary and secondary adrenal insufficient subgroups. Nor patients reported adrenal crisis neither required hospitalization [128].…”

“…Reasons for the observed longer duration of highly suggestive symptoms along with higher prevalence of gastrointestinal symptoms in controls were suggested to be the more rigorous behaviours adopted by the patients' group due to the detailed instructions in the management of infectious complications routinely received during follow-up. Moreover, it was speculated that cytokine release in the gastrointestinal tract, could have been mitigated in patients by chronic glucocorticoid treatment [128]. Therefore, it could be hypothesized that patients with adrenal insufficiency who are adequately treated and trained do not have higher risk for COVID-19 although since only a few patients had a nasopharyngeal swab these data needs cautious interpretation.…”

“…Noteworthy, recent findings hypothesized possible beneficial effects in severe COVID-19 for both dexamethasone and methylprednisolone [130] likely via inhibition of SARS-CoV-2 entry into cells by binding to ACE2 [131]. Use of high dose potent exogenous glucocorticoids may result in suppression of hypothalamic-pituitary-adrenal axis and consequent adrenal insufficiency depending on dose, duration of treatment and individual sensitivity to the drug [128].…”

COVID-19 and endocrine and metabolic diseases. An updated statement from the European Society of Endocrinology

“…Moreover, in patients with adrenal insufficiency, there could be a higher risk of an adrenal crisis after the infection [ 87 ]. However, in a recent survey of more than 200 Italian patients with primary or secondary adrenal insufficiency on regular follow-up and adequately trained, similar incidence of symptoms potentially related to SARS-CoV-2 infection as well COVID-19 severity as compared to controls were reported [ 88 ].…”

Secondary Adrenal Insufficiency: New Aspects of Diagnosis and Therapy

“…Некоторые авторы сообщали о повышенном риске развития инфекций у пациентов с НН, возможно, в связи с нарушением функционирования иммунной системы [36]. Однако, согласно результатам ретроспективного исследования M. Martino и соавт., в когорте из 121 пациента с НН COVID-19 диагнос тирован только у одного больного (распространенность -0,8%) [37].…”