Significant risk of COVID-19 and related-hospitalization among patients with adrenal insufficiency: A large multinational survey

Abstract

ObjectiveTo determine self-reported incidence and potential risk factors for COVID-19 in patients with adrenal insufficiency (AI).MethodsA 27-item AI survey was developed for AI and COVID-19 status, vetted by specialists and patients, and distributed via social media, websites, and advocacy groups. Participation was voluntary and anonymous. Data were collected from September 20th, 2020 until December 31st, 2020.ResultsRespondents (n=1291) with self-reported glucocorticoid treatment for AI, completed the survey, with 456 who reported having symptoms and were screened for COVID-19 during 2020; 40 tested positive (+ve), representing an 8.8% incidence. Of the COVID-19+ve, 31 were female (78%), with mean age of 39.9 years. COVID-19 among AI patients occurred most commonly in those aged 40–59 years (n=17; 42.5%); mean time since AI diagnosis was 13.5 years (range 0.2−42.0 years). Pulmonary disease, congenital adrenal hyperplasia, and higher maintenance doses of glucocorticoids were significantly associated with +ve COVID-19 (p=0.04, p=0.01, and p=0.001, respectively. In respondents the cumulative incidence of COVID-19+ve during 2020 was 3.1%; greater than the 1.03% worldwide-incidence reported by WHO, by December 31st, 2020. There was a 3-fold (95% CI 2.16-3.98) greater relative risk (RR) of COVID-19 infection and a 23.8- fold (95% CI 20.7-31.2) RR of hospitalization in patients with AI, compared with the global population.ConclusionA markedly raised RR of COVID-19 and hospitalization in respondents reporting chronic AI was detected. We found that a diagnosis of congenital adrenal hyperplasia, age>40 years, male gender, pulmonary disease, and higher maintenance doses of glucocorticoids were associated with greatest risk.

Pituitary and SARS CoV-2: An unremitting conundrum

“…However, with the increased availability of testing and treatment protocols during the pandemic, more rigorous studies illustrate a different picture. The relative risk for confirmed SARS-CoV-2 infection and hospitalization among patients with AI was 3-fold and 23.8-fold higher, respectively, versus general population [110] . Older age, known pulmonary disease and higher replacement doses of glucocorticoids were associated with higher risk [110] .…”

“…The relative risk for confirmed SARS-CoV-2 infection and hospitalization among patients with AI was 3-fold and 23.8-fold higher, respectively, versus general population [110] . Older age, known pulmonary disease and higher replacement doses of glucocorticoids were associated with higher risk [110] .…”

Increased risk of hospitalization, intensive care and death due to COVID‐19 in patients with adrenal insufficiency: A Swedish nationwide study

“…There are very few studies on the outcome of patients with AI and COVID-19 during the pandemic. Eight crosssectional studies have described self-reported outcome in patients with AI during suspected COVID-19 infection [15][16][17][18][19][20][21][22]. One of the studies, which included patients with benign pituitary lesions without AI as controls, reported no difference between patients with AI compared with patients without AI with respect to symptoms or hospitalization at the start of the pandemic [15].…”

“…Three of the studies showed that psychological well-being was negatively affected by the pandemic [16,17,19]. One multinational survey reported increased incidence and increased hospitalization for COVID-19 among AI patients compared with the global population, with older age, male sex, congenital adrenal hyperplasia and higher GC replacement doses being associated with worse outcome [18]. A Swedish multicentre questionnaire survey including 615 patients with autoimmune Addison's disease showed that 17% of the cohort contracted COVID-19, but few of the patients needed hospitalization [20].…”

“…Data on outcome following COVID-19 infections in patients with AI are sparse due to the rarity of the disorder, and evidence is limited by small sample sizes, heterogeneity in terms of study designs and a general lack of matched control groups [15][16][17][18][19][20][21][22]. The aim of this study was therefore to investigate the risk of contracting COVID-19, as well as the risk of hospital admission, intensive care and death due to COVID-19, in a nationwide unselected cohort of patients with AI.…”