Endocrine Abstracts

Introduction

We are currently mid Covid-19 pandemic. In the last year there have been 116, 135, 492 confirmed Covid-19 cases worldwide, with an estimated 2, 581, 976 deaths.

The RECOVERY trial reported for patients hospitalized with Covid-19, the use of dexamethasone (6 mg for 10 days) resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomisation. Adrenal insufficiency (AI) is a serious, potentially life-threatening side effect of glucocorticoids which cause suppression of the hypothalamic-pituitary-adrenal (HPA) axis.

Objective

We aimed to investigate the effects of Covid dexamethasone protocols on adrenal function.

Methodology

We collected data from patients admitted with a diagnosis of Covid-19 by searching electronic patient records from November 2020 to March 2021 at our institution. We included patients with a diagnosis of COVID-19 treated with Dexamethasone, Hydrocortisone, or prednisolone for 7 days or more. We also recorded factors that may also affect adrenal function including.

• Patients on long term corticosteroids (i.e inhaled, topical, injectable, and oral)

• Patients on CYP3A4 enzyme inhibitors

• Patients on opioids

Adrenal function was screened by 0900 h cortisol, at least 24 hours off of steroids. Cortisol levels >300 nmol/l excluded adrenal insufficiency. levels between 100-300 nmol/l underwent further assessment. Concentration <100 nmol started on hydrocortisones replacement and further surveillance.

Results

77 patients were alive at the time of data collection, data being available for 53. 42/53 patients had 7–10 days 6 mg dexamethasone whilst 9/53 had additional ARDS regimen of dexamethasone (reducing dose over 12 days starting at 33 mg/day). To date 13/50 had suboptimal cortisol level, 5 had cortisol <100 nmol 24-48 hours post stopping Dexamethasone, 4 of these having had ARDS regimen of prolonged dexamethasone. These have been started on hydrocortisone and further testing planned when on lower doses of hydrocortisone. 8 had cortisol 100-300 nmol/l, confirmatory testing is awaited. Data is therefore awaited for 27 patients along with the SST results.

Summary

Whilst this is a small data series it highlights the risk of adrenal insufficiency after treating with dexamethasone, with almost 50% of patients on ARDS regimen on ICU having adrenal insufficiency. It is important to be aware and screen for AI as these patients will be at risk of adrenal crisis if left undiagnosed. These data also suggest that Covid-19 itself does not cause adrenal insufficiency. Larger numbers are needed to confirm these data.