The Impact of the COVID-19 Pandemic on Self-Reported Outcomes in Patients With Adrenal Insufficiency

Abstract

Context The COVID-19 pandemic has impacted healthcare environment. Objective To determine the impact of the pandemic on self-reported outcomes in patients with adrenal insufficiency (AI). Design and setting Prospective longitudinal survey study at 2 tertiary centers. Participants Patients with AI. Intervention Patient-centered questionnaire. Main outcome measures Depression Anxiety Stress Scales-21, Short Form-36, and AI self-management. Results Of 342 patients, 157 (46%) had primary AI, 109 (32%) had secondary AI, and 76 (22%) had glucocorticoid-induced AI. When compared to prepandemic, daily glucocorticoid dose and number of adrenal crises did not change. However, patients reported a higher financial impact from AI (34% vs 23%, P = 0.006) and difficulty accessing medical care (31% vs 7%, P < 0.0001) during the pandemic. A third of patients reported difficulty managing AI during the pandemic. After adjusting for duration and subtypes of AI, younger patients [odds ratio (OR) 2.3, CI 95% 1.3-4.1], women (OR 3.7, CI 95% 1.9-7.1), poor healthcare access(OR 4.2, CI 95% 2.3-7.7), lack of good insurance support (OR 2.8, CI 95% 1.3-5.9), and those with a higher financial impact (OR 2.3, CI 95% 1.3-4.3) reported greater difficulties managing AI. Patients were more likely to report a higher anxiety score (≥8) if they found managing AI challenging during the pandemic (OR 3.0, CI 95% 1.3-6.9), and had lower Physical Component Summary (OR 4.9, CI 95% 2.2-11.0) and Mental Component Summary (OR 4.1, CI 95% 1.8-9.5) scores prior to the pandemic. Conclusions A third of patients with AI reported difficulties with management of AI during the pandemic, particularly in younger patients, women, and those with poor healthcare access.

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

“…Limitations include potential self-selection bias, inability to verify diagnosis and recall bias. We believe that several factors help to minimize these limitations including the wide distribution and the size of the sample in this study and the current emphasis on the patient’s disease knowledge, empowerment and need for self-management ( 4 , 6 , 7 ). Direct access to ones own electronic medical records that contain diagnosis and comorbid conditions, plus the availability of medical information on the internet, has resulted in a much more, well informed patient population, regardless of diagnosis.…”

“…Infection, in steroid dependent patients with AI, is the primary driver of adrenal crises and high mortality risk (3)(4)(5). This risk has been compounded since 2020 by emotional distress, limited access to medical practitioners associated with pandemic restrictions and staff availability, heightening the need for patient disease knowledge and self-management (4,6,7). With the more recent emergence of highly contagious SARS CoV-2 variants such as Omicron and BA.5, coupled with the difficulty predicting future mutations, providing patients with data-derived information to demonstrate level of risk more clearly may be helpful to reinforce the need for ongoing protective behaviors and strategies to mitigate high risk of infection, COVID-19 complications, adrenal crisis and catastrophic outcomes.…”

The Relationship between COVID-19 and Hypothalamic–Pituitary–Adrenal Axis: A Large Spectrum from Glucocorticoid Insufficiency to Excess—The CAPISCO International Expert Panel

“…The last study again noted low prevalence and no need for hospitalization or reported adrenal crisis in 159 patients with secondary AI [84]. A more recent longitudinal survey conducted in two tertiary medical centers in the US confirmed these findings with a significantly lower prevalence of COVID-19 among AI patients compared to the overall population (1.8% vs. 7.9%) [85]. Therefore, based on all the reported data so far, there is no evidence to suggest that patients with primary or secondary AI are at increased risk of SARS-CoV-2 infection or a severe COVID-19 course if they are adequately educated about procedures during infection [75,81].…”

Frequently Asked Questions in Patients With Adrenal Insufficiency in the Time of COVID-19

“…Another study reported that among 159 patients taking steroid replacement therapy for pituitary disease, 30 patients (18.9%) reported symptoms of COVID-19 infection, but only two of the seven patients tested for COVID-19 infection resulted to be positive (22). Finally, a recent longitudinal survey study performed in 2 tertiary medical centers of the US confirmed a lower prevalence of COVID-19 infection in AI patients compared with overall prevalence (1.8% versus 7.9%, respectively) (23). All infected patients reported mild symptoms and were managed at home.…”