Endocrine Abstracts

Coronavirus disease caused by SARS-CoV-2 virus (Covid-19) is associated with a variable clinical syndrome, ranging from a mild-moderate to a severe disease, progressing towards acute respiratory distress syndrome. Hypocortisolism is associated with a depletion of innate immunity and disruption of immune response, which could contribute to an increased risk of infection and development of a severe disease. Glucocorticoid (GC) replacement therapy(GCRT), especially if administered in a non-circadian fashion, may result in immunosuppression favouring infection and disease progression. Sick day rules for GCRT during infections are still largely tailored empirically. The aim of the current study was to investigate clinical syndrome and disease duration of Covid-19, and to evaluate GCRT adjustments, in a cohort of patients with hypocortisolism who developed Covid-19. The study was performed on 20 patients [12F,8M, 16-62 years(39.2±12.5), 11 adrenal insufficiency(AI), 9 congenital adrenal hyperplasia(CAH)], adequately treated with GCs[hydrocortisone equivalent doses, HC-Eq: 10-45 mg/day(27.25±10.09)]. A purpose-built questionnaire was administered by a phone-survey, aimed at assessing Covid-19 signs and symptoms, disease duration, the occurrence of adrenal crises, the need of GCRT adjustment, and intervention for Covid-19 (antibiotics, GCs, oxygen therapy, and hospitalization), as well as persistent clinical syndrome of Covid-19 after the disease cure (Long-Covid). The most frequent symptoms and signs were ageusia(75%), anosmia(70%) and fever(70%). Additional symptoms and signs were myalgia(65%), fatigue(60%), headache(50%), cough(50%), dyspnea(30%), and diarrhea(25%). The disease duration was of 11-49days(25.55±9.71) and no adrenal crises were reported. To manage hypocortisolism, according to general sick day rules, six(30%) patients doubled oral dose of GCRT for 2-28days(11±9.28) and no patients used parenteral GCs. To manage Covid-19, nine(45%) patients received antibiotics for 5-10days(7.22±2.16)[azithromycin 600 mg/daily(55.6%), cefixime 400 mg/daily(22.2%) and amoxicillin-clavulanic acid 1750/250 mg/daily(22.2%)]; four(20%) GCs for 7-17days(10.25±4.71) [methylprednisolone 4 mg/daily(25%), deflazacort 6 mg/daily(25%), betamethasone 1 mg/daily(25%) and prednisone 25 mg/daily(25%), HC-Eq. 20-100 mg/day(41.66±39.01)], but no patients required oxygen therapy or hospitalization. No fatal events were observed over the Covid-19 period. The most frequent Long-Covid symptoms and signs were fatigue(30%), anosmia(15%) and ageusia(10%). No significant differences were observed comparing females and males, as well as AI and CAH patients. In conclusion, patients with hypocortisolism, adequately treated with GCs, display a mild-moderate Covid-19 disease course, mainly characterized by ageusia, anosmia and fever, without severe complications and adrenal crises, and requiring a double dose of oral GCRT in less than one third of cases, different GCs in a minority of cases, and not requiring oxygen therapy and hospitalization, with persistent fatigue, anosmia and ageusia as the most common Long-Covid manifestations.