Endocrine Abstracts

Background: People with Primary adrenal insufficiency (PAI) were identified as a vulnerable group by the UK government during the COVID-19 pandemic. Hence our aim was to evaluate the incidence of COVID-19, and associated adrenal crisis (AC) in people with PAI in the UK.

Methods: A prospective observational study of patients with PAI was performed between January-June 2022. Participants were recruited via the Addison’s Disease Self Help Group. Diagnosis of PAI was self-reported, but required fludrocortisone to be prescribed. Participants were contacted using weekly SMS messages. The messages contained a link where respondents affirmed their consent and answered four questions (if they had been unwell, increased their steroids, developed AC or sought support). COVID-19 diagnosis was self-reported based on a lateral flow or PCR. AC was defined as per Hahner et. al (2015) criteria.

Results: 82 patients were recruited and 75 responded to the weekly messages. 63 (84%) were women. 66 (88%) with Addison’s disease, 7 (9.3%) had Bilateral adrenalectomy/haemorrhage and 2 (2.7%) with congenital adrenal hyperplasia. 29/75 (38.7%) developed COVID-19. Of these 8/29 (27.6%) increased their steroid medication to the COVID recommended regimen of 20 mg/6hrly. In addition, 10 (34.5%) participants doubled their dose, 6 (20.7%) more than their doubled dose, but this did not equate to the same as the 6hrly regimen. However, 4 (13.8%) participants less than doubled, and one reported taking extra but no dose stated. One participant was admitted to hospital with an AC, having only increased their hydrocortisone dose by 10 mg and did not administer emergency hydrocortisone injection.

Conclusion: During the pandemic COVID-19 infections were common in people with PAI, but AC was rare. Most patients adjusted their glucocorticoid dose appropriately, which probably contributed to the low risk of AC. Hence, appropriate education can possibly prevent the occurrence of AC during the pandemic.