Impact of COVID-19 pandemic on psychophysical stress in patients with adrenal insufficiency: the CORTI-COVID study

Martino, Marianna; Aboud, Nairus; Cola, M F; Giancola, Giulia; Ciarloni, Alessandro; Salvio, Gianmaria; Arnaldi, Giorgio

doi:10.1007/s40618-020-01422-2

Cited by 21 publications

(16 citation statements)

References 24 publications

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“…Thus, steroid replacement may result in either hypo-or hypercortisolism and both these conditions could predispose to SARS-CoV-2 infection [10,11]. In a recently published retrospective study on 121 patients with Addison's disease under steroid supplementation, only 1 of them (0.8%) developed COVD19 [12]. It seems therefore that hypoadrenalism associated with ACC under treatment with mitotane could be associated with a higher frequency of COVID 19 than hypoadrenalism resulting from non-neoplastic diseases.…”

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confidence: 99%

Frequency and outcome of SARS-CoV-2 infection in patients with adrenocortical carcinoma followed at a reference center in Italy

et al. 2021

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rapidly expanded and swiftly led to a public health crisis worldwide.Cancer patients infected by SARS-CoV-2 are at greater risk for severe illness and related death than general population, depending on primary malignancy, disease stage and type of treatment received [1][2][3].Adrenal cortical carcinoma (ACC) is a rare endocrine malignancy which has several peculiarities compared to the other malignancies: (1) ACC may produces steroid hormones in over 50% of cases, (2) most ACC patients are treated long term with mitotane, an adrenolytic drug which requires steroid coverage; (3) ACC patients with advanced disease are often treated with mitotane associated to chemotherapy which leads to additional immunosuppression [4]. All these features place ACC patients potentially at high risk of SARS-CoV-2 infection and relevant complications. No data are up to now available on frequency and outcome of SARS-CoV-2 infection in ACC patients.The medical oncology of the Azienda Socio-Sanitaria Territoriale-Spedali Civili of Brescia is a referral center for ACC in Italy. It is located in Lombardy, the Italian region that recorded the highest number of people infected with the virus. This retrospective monocentric study was undertaken to provide data on whether ACC patients are at greater risk of contracting SARS-CoV-2 infection than patients with other malignancies and the general population, and whether the viral infection in ACC patients has a worse prognosis.During the Coronavirus disease (COVID-19) pandemic, 92 ACC patients were followed at the Brescia Oncology Unit. They were 36 (39.1%) males and 56 (60.9%) females, median age 55 years (range 23-83), of whom 49 (53.2%) patients have been radically operated and were free of disease. Twenty-three of them (46.9%) were on adjuvant mitotane therapy [5]. Among the 43 patients with metastatic disease, 25 (58.1%) were treated with mitotane, 18 (41.8%) were receiving chemotherapy + mitotane as follows: first line EDP (Etoposide, Doxorubicin, Cisplatin) [6] in 8 patients; second/third line therapies with temozolomide [7] in 5 patients (4%) and gemcitabine-capecitabine [8] in 5 patients (5%). Forty-seven patients (51.1%) were resident in Lombardy while the remaining 45 lived in the rest of Italy.Six ACC patients (6.5%) developed COVID-19 symptoms, five of them resident in Lombardy. The frequency of symptomatic SARS-CoV-2 infection in ACC patients living in Lombardy was as high as 10.9%. In the same period, 1163 cancer patients with breast, lung, gastrointestinal, head and neck, melanoma and sarcoma primary malignancies received antineoplastic therapies at the Brescia Oncology Unit, which consisted in chemotherapy (50.1%), immunotherapy (13.4%) and molecular target therapies (36.5%). Twenty-nine patients (2.5%) developed symptomatic SARS-CoV-2 infection and 8 of them (27.0%) died.As shown in Table 1, all ACC patients developing COVID-19 symptoms were receiving mitotane at a dose ranging between 0.5 and 6.0 g daily. M...

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Frequency and outcome of SARS-CoV-2 infection in patients with adrenocortical carcinoma followed at a reference center in Italy

et al. 2021

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“…This study also found that patients with adrenal insufficiency (AI) and having COVID-19 infections did not display severe disease complications that required hospital admission or that an increased rate of AC was reported 32 . However, AC does occur in AI patients with COVID-19 infections 33 , and the pandemic-related stress might account for some glucocorticoid up-titrations 34 . At the start of the pandemic, the need for education (sick day rules, stringent social distancing rules), equipment (sufficient glucocorticoid supplies, steroid emergency self-injection kit) and empowerment (steroid emergency card, COVID-19 guidelines) to prevent adrenal crises was highlighted by the European Endocrine Society 35 .…”

Section: Discussionmentioning

confidence: 99%

The ISAQ Score Does Not Predict Adrenal Crisis in Patients with Primary Adrenal Insufficiency

Quinkler¹,

Kienitz²

2022

Exp Clin Endocrinol Diabetes

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Objective This study aimed to investigate the ability of the immune system assessment questionnaire (ISAQ) to predict adrenal crisis (AC) and infectious events in patients with primary adrenal insufficiency (PAI). Design This was a prospective single-centre study over three years. Methods Patients answered the ISAQ at baseline and were seen every 4–6 months in the endocrine outpatient clinic. At each visit previous infectious periods which required an increase in daily glucocorticoid dosage and AC were reported and documented. Seventy-five patients with PAI (53 women; 43 patients with autoimmune PAI, 20 patients with salt-wasting congenital adrenal hyperplasia and 12 patients who underwent bilateral adrenalectomy) were analysed. Due to the COVID-19 pandemic and consecutive lockdown measures, the data were analysed separately for March 2018 to March 2020 (period 1), and March 2020 to March 2021 (period 2). Results During period 1 the ISAQ score significantly correlated with the number of reported infectious events (r=0.351; p<0.01), but not during period 2 (r=0.059, p=0.613), in which the number of infectious events per patient-year significantly decreased (1.1±0.1 vs 0.4±0.1; p<0.001). The frequency of AC decreased from 8.8 to 2.4 per 100 patient-years between the two study periods. The ISAQ score was not different between patients with or without AC. Conclusions The ISAQ score does not identify patients prone to ACs. The COVID-19 pandemic and consecutive lockdown measures significantly diminished the frequency of infectious events and ACs.

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“…In addition, no adrenal crises were reported, but pandemic-related stress accounted for 6/14 glucocorticoid up-titrations. No differences were observed amongst primary and secondary adrenal insufficiency; whereas survey results showed concerns regarding patients’ personal health and economic status, confirming that even under unconventional stress, adequately trained patients preserve a good quality of life [ 91 ].…”

Section: Sars-cov-2 Infection In Patients With Hypopituitarismmentioning

confidence: 99%

COVID-19 and hypopituitarism

Frara

Loli

Allora

et al. 2021

Rev Endocr Metab Disord

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Besides the pulmonary manifestations caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), an emerging endocrine phenotype, which can heavily impact on the severity of the syndrome, has been recently associated with coronavirus disease 2019 (COVID-19). Patients with pituitary diseases or the pituitary gland itself may also be involved in COVID-19 clinical presentation and/or severity, causing pituitary apoplexy. Moreover, hypopituitarism is frequently burdened by several metabolic complications, including arterial hypertension, hyperglycemia, obesity and vertebral fractures, which have all been associated with poor outcomes and increased mortality in patients infected by SARS-CoV-2. This review will discuss hypopituitarism as a condition that might have a bidirectional relationship with COVID-19 due to the frequent presence of metabolic comorbidities, to the direct or indirect pituitary damage or being per se a potential risk factor for COVID-19. Finally, we will address the current recommendations for the clinical management of vaccines in patients with hypopituitarism and adrenal insufficiency.

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Impact of COVID-19 pandemic on psychophysical stress in patients with adrenal insufficiency: the CORTI-COVID study

Cited by 21 publications

References 24 publications

Frequency and outcome of SARS-CoV-2 infection in patients with adrenocortical carcinoma followed at a reference center in Italy

Frequency and outcome of SARS-CoV-2 infection in patients with adrenocortical carcinoma followed at a reference center in Italy

The ISAQ Score Does Not Predict Adrenal Crisis in Patients with Primary Adrenal Insufficiency

COVID-19 and hypopituitarism

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