ESPE2022 Poster Category 1 Adrenals and HPA Axis (52 abstracts)
Incidence and severity of Coronavirus Disease 2019 (COVID-19) in children with primary and secondary adrenal insufficiency during the pandemic in Italy
Cristina Moracas 1 , Gianni Russo 2 , Federico Baronio 3 , Rita Ortolano 3 , Marianna Rita Stancampiano 2 , Paolo Cavarzere 4 , Thomas Zoller 4 , Silvia Longhi 5 , Maria Felicia Faienza 6 , Giuseppa Patti 7,8 , Maria Elisabeth Street 9 , Chiara Guzzetti 10 , Mariella Valenzise 11 , Claudia Giavoli 12,13 , Mariacarolina Salerno 1 & Donatella Capalbo 14
1Pediatric Endocrinology Unit, Department of Translational Medical Sciences, Center for Rare Endocrine Conditions (Endo-ERN), University of Naples Federico II, Naples, Italy; 2Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; 3Department Hospital of Woman and Child, Pediatric Unit, Center for Rare Endocrine Conditions (Endo-ERN), IRCCS - S.Orsola-Malpighi University Hospital, Bologna, Italy; 4Pediatric C Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy; 5Department of Pediatrics, Regional Hospital, Bolzano, Italy; 6Department of Biomedical Sciences and Human Oncology, Pediatric Unit, University of Bari "A. Moro", Bari, Italy; 7Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy; 8Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy; 9Department of Mother and Child, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy; 10Pediatric Endocrine Unit and Neonatal Screening Center, Pediatric Hospital Microcitemico A. Cao, Cagliari, Italy; 11Pediatric Unit, Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; 12Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; 13Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 14Pediatric Endocrinology Unit, Department of Mother and Child, Center for Rare Endocrine Conditions (Endo-ERN), University Hospital Federico II, Naples, Italy
Background: Adrenal insufficiency (AI) is a rare condition caused by an inadequate production of glucocorticoids. Preliminary data in adults suggest that AI could be associated with an increased susceptibility to infections; moreover, AI patients are at risk to develop a severe course of infectious diseases and to experience a life-threatening adrenal crisis. The aim of our study is to evaluate the severity and the outcome of COVID-19 in pediatric AI patients in comparison to subjects affected with other endocrinopathies not involving adrenal gland.
Patients and Methods: This was a retrospective, multicenter study involving 11 Italian tertiary-centers of pediatric endocrinology. Data regarding symptoms, severity and duration of the disease, the need to increase the dose or receive parenteral administration of hydrocortisone and the outcome were collected through a telephone interview and review of patient’s medical files. From March 2020 to October 2021, 80 children with a history of COVID-19 were collected: 49 subjects affected by AI (42 primary AI, 7 central AI) and 31 subjects as controls.
Results: Mean age was comparable between patients and controls (11.4±4.4 years vs 10±3.5 years, respectively). The frequency of signs/symptoms during COVID-19 in AI patients was as follows: fever 68%, rhinorrhea 34%, headache 34%, sore-throat 30%, cough 28%, anosmia/ageusia 21%. Less common symptoms were characterized by arthralgia, abdominal pain, diarrhea and vomiting. The severity of infection was comparable between patients and controls: paucisymptomatic 40.8% vs 25.8%; mild 55.1% vs 61.3%; severe 4.1% vs 12.9%, respectively (Chi-square=0.19). Time between the first positive nasopharyngeal swab and the first negative one in patients vs controls was: ≤15 days, 39% vs 56.6%; >15 days, 61% vs 43.3%, showing a tendency to longer infection in AI children, although this difference did not reach statistical significance (Chi-square=0.14). In 64% of AI patients the dose of hydrocortisone was increased during the infection and in 6.4% parenteral hydrocortisone was needed. 94% of AI subjects did not require hospitalization while only 6% were hospitalized with a complete recovery in 100% of cases. Within the entire cohort of AI subjects, 2 children (4%) experienced an adrenal crisis during infection. No fatal events occurred.
Conclusion: Our data, suggest that children with AI adequately treated are not at increased risk of severe course of COVID-19. In comparison to controls, subjects with AI have a slightly longer duration of the disease, although this data need to be confirmed on larger sample of patients.
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