Endocrine Abstracts

Introduction: The RECOVERY trial² reported patients with Covid-19 receiving requiring invasive mechanical ventilation or oxygen that the use of dexamethasone (6 mg for 10 days) resulted in lower 28-day mortality. Adrenal insufficiency (AI) from hypothalamic-pituitary-adrenal (HPA) axis suppression³ is a serious, potentially life-threatening side effect of glucocorticoids treatment.

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 treated with dexamethasone or hydrocortisone by searching electronic patient records from November 2020 to March 2021 at our institution. Adrenal function was screened by 09:00 am cortisol, at least 48 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.

Results: 79 patients were alive at the time of initial data collection. 51/79 patients had 7-10 days 6 mg dexamethasone whilst 28/79 had additional ARDS regimen of dexamethasone. 8 of this group died, and data available for 60 patients. 18/60 had suboptimal cortisol level (<300nmol/l) and 5/60 had cortisol <100 nmol 48 hours after stopping dexamethasone, 4 of these having had ARDS regimen of prolonged dexamethasone. 10 patients recovered their axis prior to confirmatory testing within 1-4 weeks. Confirmatory testing undertaken SST (Short Synacthen test) on 6/18 patients. 5 had satisfactory results, 1 of them unable to attend yet.

Summary: These data demonstrate minimal risk of adrenal insufficiency after treating with Recovery doses of dexamethasone 6 mg. Almost 50% of patients on ARDS regimen on ICU had early evidence adrenal insufficiency- rate of recovery unclear because of deaths in this cohort. This cohort may need steroid cover for invasive procures such as tracheostomy, but this currently remains unclear. These data also suggest that Covid-19 itself does not cause adrenal insufficiency which is reassuring.