ESPE Abstracts

Introduction: Coronavirus disease 2019 (COVID-19) poses a serious risk to individuals with adrenal insufficiency (AI), making them more susceptible to infections and COVID-19 infection-induced adrenal crises, impacting their life expectancy and quality of life (QoL).

Methods: We conducted a retrospective case-control study at Severance Children's Hospital in South Korea from June 2019 to December 2022. We enrolled 94 patients with AI (31.9% primary AI, 68.1% secondary AI) and 79 controls (patients with benign pituitary lesions without AI). All patients with AI had been previously educated to modify their replacement therapy on stress doses. Through questionnaires and database, we assessed COVID-19 infection frequency, symptoms, actual used doses, adrenal crisis occurrence, and physiologic and psychosocial stress. QoL scores were compared using the revised Short-Form-36 (SF-36) Health Survey, focusing on personal health, emotion, social interactions, and school or occupation-related challenges.

Results: Data showed that patients with AI experienced less COVID-19 infections compared to the control group (47.9% vs 84.8%, P < 0.001). Adrenal crisis affected 4.3% of AI patients, with 2 requiring intensive care. Incidence of adrenal crisis, dose of glucocorticoids and ACTH/cortisol levels did not significantly differ before and after the pandemic, although 18.3 % of AI patients required stress dose-up for short term. AI patients expressed higher concerns about overall health, but education on COVID-19 stress situations led to a significant reduction in AI-related concerns. Regarding QoL, AI patients showed higher concerns in health (P = 0.003) and relationship (P = 0.049) aspects compared to the control group.

Conclusions: Properly managed and trained educated AI patients had comparable or reduced rates of COVID-19 infection. Addressing AI patients' health and social concerns, particularly regarding relationships, is crucial during the pandemic.