Endocrine Abstracts

Background: Patients with primary adrenal insufficiency (PAI) carry an increased risk of infections which can precipitate adrenal crises. They are thought to be more likely to contract COVID-19 and develop severe disease; however, little is known about the true impact of COVID-19 on these patients.

Objectives: To assess the response of a large single-centre cohort of PAI patients to COVID-19, focusing on morbidity and health promotion attitudes.

Methods: In May 2020 we posted COVID-19 advice to all PAI patients under the care of a large secondary and tertiary centre, including guidance on stringent social distancing. Through January-April 2021, we conducted a telephone survey with a semi-structured questionnaire.

Results: 162 of 256 contacted patients responded (82 with Addison’s disease, AD; 80 with congenital adrenal hyperplasia, CAH). AD patients were older (median 51 vs. 39 years) and had a higher prevalence of autoimmune diseases (42.7% vs. 10.0%) and other comorbidities (Charlson comorbidity index ≥2 in 47.6% vs. 10.0%) (all P<0.05). 47 patients (29.0%) had confirmed or suspected COVID-19, the second most common cause of sick day dosing during the pandemic. 15 patients (9.3%) had confirmed COVID-19, similar to the infection rate of the general population. 18 adrenal crises occurred, and COVID-19 was the leading cause (4 cases). CAH patients carried a higher risk of confirmed or suspected COVID-19 than AD patients (68.1% vs. 31.9%), had more COVID-19 vaccine hesitancy, and were less likely to wear medical jewellery (36.3% vs. 64.6%) and have had hydrocortisone self-injection training (80.0 vs. 91.5%) (all P<0.05).

Conclusions: PAI patients provided with social distancing guidance had similar COVID-19 infection rates to the background population, but COVID-19 was a major trigger for sick day dosing and adrenal crises. CAH patients were more likely to have confirmed or suspected COVID-19 than AD patients and showed less engagement with health promotion strategies.