Endocrine Abstracts

Background: COVID-19 pandemic is a novel, potentially adverse condition for patients with adrenal insufficiency (AI), whose life expectancy and quality of life (QoL) are impaired due to their risk of infections and stress-triggered acute events. Therapeutic usefulness of glucocorticoids in COVID-19 is debated, but infected AI patients require prompt replacement tailoring.

Objectives: In a cohort of AI patients, to assess:

– the prevalence, manifestations and outcome of COVID-19;

– the prevalence of adrenal crises and their possible association with intercurrent COVID-19 and/or pandemic-related psychophysical stress;

– the emotional impact of the pandemic-induced social distancing;

– the self-reported QoL and health status during the lockdown.

Study design: Open-label, cross-sectional, monocentric study (University Hospital of Ancona, Italy) covering the period February-April 2020.

Patients and methods: 121 patients (59 males, 55 ± 17 years) with primary (n = 40) and secondary (n = 81) AI underwent a three-questionnaire telematics interview:

– purpose-built ‘CORTI-COVID’ questionnaire (34 items, 4 domains), assessing the latest medical history and the degree of concern (score 1–5) for COVID-19-related global health, AI-specific personal health, occupational consequences, economic impact and social implications;

– AddiQoL-30;

– Short-Form-36 Health Survey (SF-36).

Results were analyzed according to AI etiology. Demography, glucocorticoid replacement and comorbidities impacting COVID-19 prognosis were also considered.

Results: COVID-19 occurred in one (0.8% prevalence) 48-year-old woman with primary AI, who promptly adjusted glucocorticoid replacement. Dyspnea lasted 3 days, without requiring hospitalization. COVID-19 was not reported among alive secondary AI patients. No adrenal crises were experienced, but pandemic-related psychophysical stress accounted for 6/14 glucocorticoid stress doses. Mean CORTI-COVID score was similar between primary and secondary AI patients. The most influencing items were ‘personal health’ for the former (P = 0.881, P = 0.000) and ‘economy’ for the latter (P = 0.809, P = 0.000). Occupational concern was higher for patients affected by working restrictions. Demography, glucocorticoid replacement and comorbidities played no significant role. Mean AddiQoL-30 score was 131 ± 27 and 131 ± 25 for primary and secondary AI, respectively. Global and single-item CORTI-COVID scores were all inversely correlated with QoL. SF-36 correlated directly with AddiQoL-30, inversely with CORTI-COVID. Physical pain and general health perception were influenced by glucocorticoid dose in secondary AI. Comorbidities and, for secondary AI, gender significantly impacted both AddiQoL-30 and SF-36 scores.

Conclusions: If educational efforts are made to prevent acute events, both primary and secondary AI patients seem not at particular risk of COVID-19. CORTI-COVID is a novel, reliable questionnaire assessing the strong pandemic-related emotional burden for AI patients. Even in unconventionally stressful situations, educated patients with AI preserve a good QoL.