Endocrinology in the time of COVID-19 management of adrenal insufficiency
File(s)
Published version
Author(s)
Arlt, Wiebke
Baldeweg, Stephanie E
Pearce, Simon HS
Simpson, Helen L
Type
Journal Article
Abstract
We provide guidance on prevention of adrenal crisis during the global COVID-19 crisis, a time with frequently restricted access to the usual level of healthcare. Patients with adrenal insufficiency are at an increased risk of infection, which may be complicated by developing an adrenal crisis; however, there is currently no evidence that adrenal insufficiency patients are more likely to develop a severe course of disease. We highlight 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. In patients with adrenal insufficiency developing an acute COVID-19 infection, which frequently presents with continuous high fever, we suggest oral stress dose cover with 20 mg hydrocortisone every 6 h. We also comment on suggested dosing for patients who usually take modified release hydrocortisone or prednisolone. In patients with adrenal insufficiency showing clinical deterioration during an acute COVID-19 infection, we advise immediate (self-)injection of 100 mg hydrocortisone intramuscularly, followed by continuous i.v. infusion of 200 mg hydrocortisone per 24 h, or until this can be established, and administration of 50 mg hydrocortisone every 6 h. We also advise on doses for infants and children.
Date Issued
2020-07-01
Date Acceptance
2020-04-20
Citation
European Journal of Endocrinology (EJE), 2020, 183 (1), pp.G25-G32
ISSN
0804-4643
Publisher
Oxford University Press
Start Page
G25
End Page
G32
Journal / Book Title
European Journal of Endocrinology (EJE)
Volume
183
Copyright Statement
© 2020 The authors Published by Bioscientifica Ltd. This work is licensed under a Creative Commons Attribution 4.0 International License.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/32379699
PII: EJE-20-0361
Subjects
ADDISONS-DISEASE
CRISIS
DIAGNOSIS
Endocrinology & Metabolism
Life Sciences & Biomedicine
MORTALITY
Science & Technology
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2020-07-01