Endocrine Abstracts

Background: Primary adrenal insufficiency (PAI) predisposes patients to infections, which can precipitate life-threatening adrenal crises. PAI patients are thought to be particularly vulnerable to COVID-19; however, little is known about its true impact on this group.

Aim: To assess morbidity and health promotion attitudes during the COVID-19 pandemic amongst a large cohort of PAI patients.

Methods: In May 2020 COVID-19 information, including advice on strict social distancing and sick-day rules, was distributed to all PAI patients under a large secondary and tertiary centre. A semi-structured telephone questionnaire was used to survey these patients through January-April 2021. Data were analysed using Mann-Whitney and Fisher tests.

Results: Of 256 contacted patients, 162 responded (82 with Addison’s disease, AD; 80 with congenital adrenal hyperplasia, CAH). AD patients were significantly older (median 51 vs. 39 years) with more comorbidities (Charlson comorbidity index ≥2 in 47.6% vs. 10.0%), including autoimmune disorders (42.7% vs. 10.0%) (all P < 0.05). 47 patients (29.0%) had suspected/confirmed COVID-19, the second most common cause of sick-day dosing during the pandemic. 15 patients (9.3%) had confirmed COVID-19, a prevalence similar to the general population. 17 patients reported 18 adrenal crises, and COVID-19 was the leading precipitant (4 cases). CAH patients had a higher risk of suspected/confirmed COVID-19 than AD patients (68.1% vs. 31.9%), were less likely to have had/be planning to have the COVID-19 vaccine (80.0% vs. 96.3%), and were less likely to have undergone hydrocortisone self-injection training (80.0% vs. 91.5%) or wear medical jewellery (36.3% vs. 64.6%) (all P < 0.05).

Conclusions: PAI patients provided with COVID-19 guidance suffered similar infection rates to the general population. However, COVID-19 was a principal trigger for adrenal crises and sick-day dosing. Despite carrying a higher risk of COVID-19 than AD patients, CAH patients showed less engagement with health promotion strategies.