ESPE2021 Free Communications Adrenal (6 abstracts)
Outcome of COVID-19 infections in patients with adrenal insufficiency
Hanna Nowotny 1 , Jillian Bryce 2 , Roberta Giordano 3 , Federico Baronio 4 , Irina Chifu 5 , Martine Cools 6 , Erica L.T. van den Akker 7 , Henrik Falhammar 8,9 , Natasha Appelman-Dijkstra 10 , Luca Persani 11 , Guglielmo Beccuti 3 , Simona Grozinsky-Glasberg 12 , Alberto M. Pereira 13 , Eystein Husebye 14 , Stefanie Hahner 5 , S. Faisal Ahmed 2,15,16 & Nicole Reisch 1
1Medizinische Klinik IV, Department of Endocrinology, Klinikum der Universität München, Munich, Germany.;2Office for Rare Conditions, University of Glasgow, Glasgow, United Kingdom.;3Department of Clinical and Biological Sciences and Division of Endocrinology, Diabetes and Metabolism - Department of Medical Sciences, University of Turin, Turin, Italy.;4Pediatric Unit, Department Hospital of Woman and Child, Endo-ERN Centre IT11, IRCSS AOU S.Orsola-Malpighi University Hospital, Bologna, Italy.;5Division of Endocrinology and Diabetology, Department of Internal Medicine I, University Hospital of Wuerzburg, University of Wuerzburg, Wuerzburg, Germany.;6Department of Paediatric Endocrinology, Ghent University Hospital, University of Ghent, Ghent, Belgium.;7Department of Pediatrics, Division of Pediatric Endocrinology, Erasmus MC - Sophia Children’s Hospital, Erasmus University Center, Rotterdam, Netherlands.;8Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.;9Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.;10Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Belgium.;11Isitituto Auxologico Italiano IRCCS, and University of Milan, Milan, Italy.;12Neuroendocrine Tumor Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.;13Division of Endocrinology and Center for Endocrine Tumors, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands.;14Department of Clinical Science and KG Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway.;15Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, Netherlands.;16Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom
Background: Clinical outcome data of patients with adrenal insufficiency, who were affected by COVID-19, have been collected as a common initiative by the ESE Rare Disease Committee and ENDO-ERN via the European Registries for Rare Endocrine Conditions (EuRRECa) project.
Methods: This Webropol-based questionnaire included a total of 32 questions collecting quantitative and qualitative data. Of the 19 medical centres out of ten European countries that signed up to report on e-REC, 15 reported a total of 50 cases using the online registry and 11 centres completed the questionnaire. In total, 34 cases of adrenal insufficiency (AI) were reported.
Results: Of the 34 cases of AI reported, 28 cases (82 %) were affected by primary adrenal insufficiency (46 % Addison’s disease (n = 13), 39 % congenital adrenal hyperplasia (n = 11)). Affected AI patients had a mean age of 41 (SD 21) years at the timepoint of diagnosis and were male in 44% (15 male, 19 female). Of those 13 patients with Addison’s disease, 85 % suffered from additional autoimmune endocrine disorders. Most relevant comorbidities were hypertension (n = 6, 18 %), obesity (n = 6, 18 %) and diabetes mellitus (n = 3, 9 %). Most frequent symptoms of COVID-19 infected patients included fever (n = 20, 59 %), cough (n = 20, 59 %), tiredness or exhaustion (n =20, 56 %), muscle pain (n = 18, 53 %), headaches (n = 14, 42 %) and loss of taste and smell (n = 11, 32 %). Two thirds of patients increased their daily glucocorticoid dose from a mean of 24 mg/d (SD 14 mg/d) to a mean of 44 mg/d (SD 25 mg/d). Only one of the surveyed patients administered i.m. injection of 100 mg hydrocortisone at home. Three patients (9 %) had to be admitted to hospital due to adrenal crisis and two patients (6 %) due to the severity of infection with a mean hospitalization time of 12.2 days. One of the patients had to be transferred to the intensive care unit. One patient reported persistent disease, all other patients reported complete remission.
Conclusion: This European multicentric questionnaire is the first to collect data on the outcome of COVID-19 infection in patients with adrenal insufficiency with or without any concomitant disease. Although numbers of collected cases are relatively low, it suggests good clinical outcome in case of duly dose adjustments and emphasizes the importance of patient education on sick day rules.
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