Adrenal Insufficiency at the Time of COVID-19: A Retrospective Study in Patients Referring to a Tertiary Centre

Background: COVID-19 represents a global health emergency and infected patients with chronic diseases often present a severe impairment. Adrenal insufficiency (AI) is supposed to be associated with an increased risk of infections which could trigger adrenal crisis. Our primary aim was to evaluate the incidence of COVID-19 symptoms and complications in AI patients. Methods: We conducted a retrospective case-control study, in 279 patients with primary and secondary AI and 112 controls. By administering a standardized questionnaire by phone, we collected data on COVID-19 suggestive symptoms and consequences. As controls, we called patients with benign pituitary non-functioning lesions, without hormonal alterations. All patients were on active follow-up and lived in Lombardy, one of the most affected territory. All AI patients had been previously trained to modify their replacement therapy on stress doses. Findings: in February-April 2020, the prevalence of symptomatic patients (complaining at least one symptom of viral infection) was similar between the two groups (24% in AI and 22·3% in controls, p 0·788). Highly suggestive COVID-19 symptoms (at least two including fever and/or cough) also occurred equally in AI and controls (12·5% in both groups). No patient required hospitalization and no adrenal crisis was reported. Few nasopharyngeal swabs were performed (n=12) as indicated by sanitary regulations, limiting conclusions on the exact infection rate (two positive results in AI and none in controls, p 0·515). Interpretation: AI patients who are adequately treated and trained, seem to display the same incidence of COVID-19 suggestive symptoms and disease severity as controls. Funding: None. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The Local Ethical Committee (Fondazione IRCCS Ca’ Granda, Milan) approved the protocol study and patients gave their verbal consent to participate.