Pituitary society guidance: pituitary disease management and patient care recommendations during the COVID-19 pandemic—an international perspective

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the viral strain that has caused the coronavirus disease 2019 (COVID-19) pandemic, has presented healthcare systems around the world with an unprecedented challenge. In locations with significant rates of viral transmission, social distancing measures and enforced 'lockdowns' are the new 'norm' as governments try to prevent healthcare services from being overwhelmed. However, with these measures have come important challenges for the delivery of existing services for other diseases and conditions. The clinical care of patients with pituitary disorders typically involves a multidisciplinary team, working in concert to deliver timely, often complex, disease investigation and management, including pituitary surgery. COVID-19 has brought about major disruption to such services, limiting access to care and opportunities for testing (both laboratory and radiological), and dramatically reducing the ability to safely undertake transsphenoidal surgery. In the absence of clinical trials to guide management of patients with pituitary disease during the COVID-19 pandemic, herein the Professional Education Committee of the Pituitary Society proposes guidance for continued safe management and care of this population.

Pituitary apoplexy associated with acute COVID-19 infection and pregnancy

“…Recent recommendations by Fleseriu et al suggest categorizing COVID-19 positive patients in need of pituitary surgery as either emergent, urgent, or elective in regard to operative intervention timing. In our case, the patient fell somewhere in between urgent and elective as she appeared to have pituitary apoplexy but was stable on steroids without neurologic deterioration [19]. Non-operative conservative management was highly considered and may have in fact been the preferred option in a stable patient with pituitary apoplexy during this coronavirus pandemic given the concern for spread of the disease via aerosolization of the virus.…”

“…Of note there is recent literature indicating that patients with COVID-19 represent a very high-risk population first disseminating virus to healthcare workers during transsphenoidal surgery presumably due to aerosolization of viral particles [25]. As described in recent recommendations by the Pituitary Society, it is critical that healthcare workers performing any form of endonasal surgery carry out strict adherence to related protective strategies including no direct patient contact without the use of PPE and PAPR devices, appropriate donning and doffing techniques, and careful showering after completion of the surgical procedure [19]. These were all carried out according to recommended guidelines with no postoperative evidence of infection in any of the clinical staff involved in the care of this patient.…”

The direct and indirect impact of the COVID-19 pandemic on the care of patients with pituitary disease: a cross sectional study

“…Consequently, 267 (64.8%) patients surveyed had a change or delay to the planned care for their pituitary disease. The following three areas are time critical in the management of patients with pituitary disease: 1) visual compromise, 2) suspected cancer and 3) the effects of a functioning tumour [1]. We did not identify any patients in these groups (known to our service prior to the pandemic) who have had adverse visual outcomes or a delay in cancer diagnosis and management from a delay in care.…”

“…The worldwide spread of the viral strain that has caused the coronavirus disease 2019 (COVID-19) pandemic, along with the unprecedented pressure subsequently placed on healthcare, has promoted concerns that patients with chronic medical conditions, including those with pituitary disease, have been adversely affected [1,2].…”

Dealing with COVID-19: Through Endocrinologist’s Eyes

“…Thus, initial doses should be the lowest as possible and titrated according to the clinical response with more attention on imminent AI in case of over treatment. It should be kept in mind that mild hypercortisolemia may be better than the adrenal crisis in the short term (48).…”