Therapeutic Patient Education for Adrenal Insufficiency under
COVID-19 Pandemic Conditions

Kienitz, Tina; Hahner, Stefanie; Burger-Stritt, Stephanie; Quinkler, Marcus

doi:10.1055/a-1217-7208

Cited by 10 publications

(12 citation statements)

References 105 publications

(159 reference statements)

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“…Experts from different countries have reacted promptly to this issue by publishing recommendations on the management of steroid replacement in AI patients during the COVID-19 pandemic ( 13 , 39 , 54 , 55 ). The European guidelines for the management of AI under COVID-19 pandemic conditions recommend: 1) administering 20 mg hydrocortisone orally every 6 hours in case of “signs and symptoms suggestive of COVID-19” (sick day rule 1), and 2) in the event of clinical deterioration, that patients immediately self-inject 100 mg hydrocortisone intramuscularly and contact the emergency services for transfer to hospital (sick day rule 2) ( 39 , 56 ).…”

Section: Adrenal Insufficiencymentioning

confidence: 99%

“…Ensuring that AI patients receive the necessary education regarding “sick day rules” and are equipped with an emergency pass, an emergency kit, and adequate supplies of immediate-release glucocorticoids is mandatory for their optimal self-management in the event of an imminent adrenal crisis ( 25 , 39 , 55 ). Replacing live training sessions with telephone or online meetings to enable compliance with social distancing rules and recommendations is a feasible solution to enable all AI patients to receive the essential information ( 55 ). However, this does not cover one of the most important aspects of the training, namely practicing the self-administration of the hydrocortisone emergency injection under the direct supervision of qualified medical staff.…”

Section: Adrenal Insufficiencymentioning

confidence: 99%

“…For this reason “classic” training sessions, adapted as necessary (reducing the number of participants and the session time, mandatory wearing of face masks, keeping an appropriate distance between participants, ventilation, etc. ), should be preferred where possible ( 55 ).…”

Section: Adrenal Insufficiencymentioning

confidence: 99%

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Management of Patients With Glucocorticoid-Related Diseases and COVID-19

et al. 2021

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The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a global health crisis affecting millions of people worldwide. SARS-CoV-2 enters the host cells by binding to angiotensin-converting enzyme 2 (ACE2) after being cleaved by the transmembrane protease serine 2 (TMPRSS2). In addition to the lung, gastrointestinal tract and kidney, ACE2 is also extensively expressed in endocrine tissues, including the pituitary and adrenal glands. Although glucocorticoids could play a central role as immunosuppressants during the cytokine storm, they can have both stimulating and inhibitory effects on immune response, depending on the timing of their administration and their circulating levels. Patients with adrenal insufficiency (AI) or Cushing’s syndrome (CS) are therefore vulnerable groups in relation to COVID-19. Additionally, patients with adrenocortical carcinoma (ACC) could also be more vulnerable to COVID-19 due to the immunosuppressive state caused by the cancer itself, by secreted glucocorticoids, and by anticancer treatments. This review comprehensively summarizes the current literature on susceptibility to and outcome of COVID-19 in AI, CS and ACC patients and emphasizes potential pathophysiological mechanisms of susceptibility to COVID-19 as well as the management of these patients in case of SARS-CoV-2. Finally, by performing an in silico analysis, we describe the mRNA expression of ACE2, TMPRSS2 and the genes encoding their co-receptors CTSB, CTSL and FURIN in normal adrenal and adrenocortical tumors (both adenomas and carcinomas).

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Section: Adrenal Insufficiencymentioning

confidence: 99%

Section: Adrenal Insufficiencymentioning

confidence: 99%

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Management of Patients With Glucocorticoid-Related Diseases and COVID-19

et al. 2021

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“…Medical therapy of patients with acromegaly within the German Acromegaly Registry [20] and an observational study on the use of somatostatin receptor agonists are topics that address acromegaly [21]. Finally, an original study on hypophysitis [22] and a review on glucocorticoid replacement therapy in primary and secondary adrenal insufficiency in Covid-19 times closes the issue [23]. This special issue of Experimental and Clinical Endocrinology and Diabetes provides the interested reader with the unique opportunity to get an exceptional overview on current diagnosis and treatment of pituitary tumors written by international experts.…”

Section: Which Topics Will You Find In This Special Issue?mentioning

confidence: 99%

Pituitary in the Spotlight

Reincke

Honegger

2021

Exp Clin Endocrinol Diabetes

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The German Society of Endocrinology (DGE) has a long-standing scientific and clinical focus on the pituitary. The pituitary working group ‘Arbeitsgemeinschaft Hypophyse’ is an interdisciplinary special interest group with a focus on advancing diagnosis and treatment of pituitary conditions. On the occasion of the English publication of the S2K clinical guideline Diagnosis and therapy of clinically hormonally inactive pituitary tumors, we present here a series of 12 articles from internationally renowned authors from inside and outside of Germany.

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“…People with AI are facing their primary disease and the risk/fear of COVID-19 infection (8). Therefore, a complete awareness of diseases (AI and COVID- 19) and motivation about self-management are of paramount importance in patients.…”

Section: Introductionmentioning

confidence: 99%

Frequently Asked Questions in Patients With Adrenal Insufficiency in the Time of COVID-19

et al. 2021

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Adrenal insufficiency (AI) is a life-threatening disorder, with increased morbidity and mortality, especially in case of an acute illness that can increase the requirement of cortisol. A novel infectious disease, termed Coronavirus Disease 2019 (COVID-19), appeared in 2020. Therefore, AI patients are experiencing a novel challenge: the risk of infection. In our experience, a prompt contact to the Endocrine center (with a telemedicine consultation) and a full awareness of diseases (cortisol deficiency, COVID-19 and the self-management of an adrenal crisis) are important to motivate patients. Vaccine is an effective treatment to prevent hospitalization and aggressive course of COVID-19. Some patients manifest challenges due to inequitable access and vaccine hesitancy, resulting in a delay in the acceptance of vaccines despite the availability of vaccination services. Therefore, an effort of all physicians must be conducted in order to advise patients with AI. In this short review, we try to answer some frequently asked questions regarding the management of patients with AI.

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Therapeutic Patient Education for Adrenal Insufficiency under COVID-19 Pandemic Conditions

Cited by 10 publications

References 105 publications

Management of Patients With Glucocorticoid-Related Diseases and COVID-19

Management of Patients With Glucocorticoid-Related Diseases and COVID-19

Pituitary in the Spotlight

Frequently Asked Questions in Patients With Adrenal Insufficiency in the Time of COVID-19

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