Endocrine Abstracts

SARS-CoV-2 has rapidly spread from China throughout the world leading to a pandemic. COVID-19 can be severe enough to cause hospitalization and death. Many patients with endocrine disorders share many of the recognized risk factors for severe disease and have potential additional risks due to corticosteroid replacement therapy or alteration in blood electrolytes. We here report three cases of COVID-19 in patients with post-surgical hypopituitarism and documented hypocortisolemia. An 80 yr-old patient with hypopituitarism and diabetes insipidus after surgery for craniopharyngioma in 1990, tested positive for Sars-CoV-2 at hospital admission for cardiogenic syncope. He suffered of hypertension, mild diabetes, COPD, atrial fibrillation, vascular disease; he was on stable therapy with L-T4, high dose cortisone acetate (62.5 mg/day), intranasal desmopressin and anticoagulants. He had no symptoms nor radiological signs specific for COVID-19.Blood tests showed hyponatremia (Na⁺ 128.3 mmol/l) and increased LDH (290 U/l), CRP (82 mg/l, RR. < 6), IL6 (262 pg/ml, RR. < 7) and D-dimer (>20 mg/ml, RR. 0.27–0.77). He received a supplemental dose of parenteral hydrocortisone, optimization of desmopressin and no specific therapy for COVID-19. He was discharged after placement of a pace-maker. A 78 yr-old male patient with hypopituitarism after surgery for suprasellararachnoid cyst was on stable therapy with L-T4, cortisone acetate (25 mg/day), testosterone and growth hormone. He presented to the ER with cough, dyspnea and fever for one week. He tested positive for Sars-CoV-2; chest CT showed COVID-19 associated pneumonia. Mistakenly, cortisone acetate therapy was missed for 40 hours while staying in ER. Blood tests showed hyponatremia (Na⁺129 mmol/l) and increased LDH (230 U/l) and CRP (53 mg/l). He received low-flux oxygen, ritonavir/lopinavir and hydroxychloroquine. His clinical conditions significantly improved and he was discharged after 6 days. An 18 yr-old male with hypopituitarism after surgery for craniopharyngioma at 12 yo, severe obesity (BMI 49.5), diabetes insipidus, was on stable therapy with L-T4, hydrocortisone (25 mg/die), desmopressin, testosterone and growth hormone. He presented to the ER with fatigue and drowsinessand no respiratory symptoms. He tested positive for Sars-CoV-2. Chest X-rays showed an increase of vascular pattern in both lungs. Blood tests showed increased CRP (25 mg/l), normal IL6 and D-Dimer. He received antibiotic therapy and prophylactic anticoagulant coverage with LMWH; oral hydrocortisone was doubled. No respiratory complications occurred and the patient was discharged 3 days later. In conclusion, patients with hypopituitarism may be more susceptible to COVID-19 although severity of the disease does not seem to be increased.