Endocrine Abstracts

Introduction

Worldwide, 100 million people have been diagnosed with COVID-19. Patients with adrenal insufficiency (AI) are assumed, on the basis of expert opinion, to be at higher risk of infection.

Aim

To determine the patient reported incidence and potential risk factors of infection with COVID-19, for patients diagnosed with AI.

Method

A 42 item questionnaire (inclusive of AI diagnosis, COVID-19 symptoms, testing and concomitant diseases in 2020) was vetted by a panel of endocrine specialists and patients with AI from Patient Advocacy groups worldwide and distributed via associated websites and social media. Participation was voluntary and anonymized. Descriptive and crosstabs (Chi-squared) analysis was performed using SPSS27.

Results

Completed surveys included N = 1292 participants from 43 countries. 40/494 patients (screened for COVID-19) tested positive (31 female (78%): mean age 39.9 years (range 1.0–68.0). Highest incidence N = 19 (47.5%) was found in those 40–60 years, with a mean duration of AI of 12.7 years (range 0.17–42.0) years. Reported ethnic composition Caucasian + European 35 (87.5%), Hispanic in 3 (7.5%), African-American in 1 (2.5%) and in 1(2.5%) who did not declare this. The positive tests largely correlated with those with the greatest number of participants: UK (35%), USA (35%) and Brazil (17.5%), whereas, the total positive tests from the combination of Finland, Sweden, Estonia, Australia and Netherlands represented (12.5%) patients. COVID-19 positive patients were found to have pre-existing cardiovascular disease (16.6%) and pulmonary disease (27.7%). Of the COVID-19 positive cohort, participants with congenital adrenal hyperplasia (CAH) reported a significantly higher incidence of COVID-19 (12.9%, P = 0.001) compared with other diagnoses.

Discussion

At the time of the survey, 100 million patients worldwide were diagnosed with COVID-19, whereas 1292 participants with adrenal insufficiency completed the questionnaire, representing 12.9% of the expected numbers of respondents, based on an average prevalence of adrenal insufficiency of 100 per million. Of those who completed the questionnaire, 494 participants had been screened for COVID-19 and only 40 (8%) who tested positive, representing an annual incidence of 3.1%, which is slightly higher than the worldwide incidence of COVID19 of 1.25%.

Conclusion

Although this survey is biased by self-election, we detected a slightly higher than background incidence of COVID-19 infection for patient with AI. This may be concerning as patients with adrenal insufficiency are potentially at greater risk from respiratory illness due to impaired natural killer cell function. In particular, patients with CAH may be at especially greater risk for COVID-19.