In ENDOOnline 2020’s first session last Monday, Wiebke Arlt, MD, DSc, FRCP, FMedSci, of the University of Birmingham, updated conference attendees on steroid dosing for Adrenal Insufficient patients with COVID-19. The discussion was focused both on primary adrenal insufficiency (PAI) or Addison’s Disease and secondary adrenal insufficiency (SAI) which is typically caused by hypothalamic-pituitary disorders, the risks for patients and steroid treatment plan for patients diagnosed with COVID-19
COVID Infection Risks
Based on data, there is an increased probability of an inpatient admission for patients with adrenal Insufficiency and COVID-19, however SAI patients are at a slightly lower risk than their PAI counterparts. There is no evidence, however, that symptoms are more severe in AI patients than typically healthy patients with COVID-19.
Symptoms
General COVID-19 symptoms include new or continuous dry cough, sore throat, loss of sense of smell or taste, aches and pains and fatigue.
Hydrocortisone Dosing
Fever associated with COVID tends to be continuous and patients with normal cortisol production were shown to produce consistently high levels of cortisol in conjunction with the fever. Typical sick day rules for stress dosing AI patients include double or triple dosing at normal dosing times, but Dr. Wiebke advises 6 hour intervals would better cover the fever and symptoms. She also showed data that indicated continuous intravenous infusion (CIV) of hydrocortisone is ideal in treating hospitalized AI patients with COVID. Adult and pediatric dosages vary.
COVID Precautions
Dr. Wiebke advised endocrinologists to educate patients about general sick day rules versus COVID sick day rules and to remind patients to observe strict social distancing; to equip patients with sufficient hydrocortisone supplies, up-to-date injection kits and the endocrinologist’s emergency phone number; and to empower patients to get a hydrocortisone emergency card to present to emergency room staff.
Get an Emergency Card
As always, consult with your endocrinologist should you have questions about how to stress dose in the case of infection. Fill out the form below to download an emergency card.
