Most hypothalamic-pituitary brain tumor patients suffer from secondary adrenal insufficiency (SAI), which is the brain’s inability to signal cortisol production in the event of the body being in distress, and diabetes insipidus (DI), the which is a result of the disruption of production of the anti-diuretic hormone which causes issues with body fluid balance and blood sodium levels. With the coronavirus outbreak, many questions have been raised about patients with SAI being immunosuppressed or “high-risk.”
There are a few articles recently posted on this topic. The Journal of Clinical Endocrinology & Metabolism (JCEM) released an article online a few weeks ago for the May 2020 issue that highlights a few guidelines to consider for patients with SAI and DI. Here are a few key points:
Maintenance Dose
Patients should continue their daily maintenance dose of steroids. Even through steroid use may put patients in the COVID-19 high-risk category, not taking the daily maintenance dose puts the patient at higher risk of an adrenal crisis.
Stress Dose
Patients should revisit the “sick day rules” with physicians. In the case of COVID-19 symptoms — namely a dry cough and fever — stress dosing may be necessary. Only stress dose in the event of symptoms not to prevent symptoms. If patient conditions get worse and they are experiencing vomiting or diarrhea, seek urgent medical care.
Steroids & COVID-19
The World Health Organization (WHO) has indicated that steroids are not a treatment for COVID-19. According to JCEM, in the event of illness and hospitalization, treating physicians should administer stress dose hydrocortisone via IV.
Sickness and Diabetes Insipidus
Illness and stress dose steroids can also impact fluid management. According to the JCEM, careful monitoring of inputs and outputs while factoring in insensible losses due to fever to avoid sodium imbalances are important considerations especially if the patient have impaired consciousness due to illness.
Preparing for a Hospitalization
Given that patients with SAI or DI may need to be hospitalized from time-to-time outside of a global health crisis, it is advisable to check with your treating hospital on a regular basis to be aware of the hospital visitor guidelines in place and any other policy changes that might affect you. Have an up-to-date emergency letter from your endocrinologist to provide on arrival to the hospital. If you don’t have a letter, a concise documentation of your health history is useful as well.
Conclusion
Hopefully this helps better understand the information that is available on these conditions as related to COVID-19. It is best to continue to maintain the CDC guidelines of practicing social distancing, staying home when possible and wearing a mask to prevent the spread to stay healthy and keep yourself and others safe.
Sources
Our Response to COVID-19 as Endocrinologists and Diabetologists
Ursula B Kaiser, Raghavendra G Mirmira, Paul M Stewart
The Journal of Clinical Endocrinology & Metabolism
If you are at higher risk: How to reduce risk of infection and what to do if you get sick
Harvard Health Publishing
Managing patients with endocrine dysfunction during COVID-19
Medical News Today
What to Know if You Have an Endocrine Disease During the Coronavirus Pandemic
U.S. News & World Report
