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Abstract
We provide guidance on prevention of adrenal crisis during the global COVID-19 crisis, a time with frequently restricted access to the usual level of healthcare. Patients with adrenal insufficiency are at an increased risk of infection, which may be complicated by developing an adrenal crisis; however, there is currently no evidence that adrenal insufficiency patients are more likely to develop a severe course of disease. We highlight the need for education (sick day rules, stringent social distancing rules), equipment (sufficient glucocorticoid supplies, steroid emergency self-injection kit) and empowerment (steroid emergency card, COVID-19 guidelines) to prevent adrenal crises. In patients with adrenal insufficiency developing an acute COVID-19 infection, which frequently presents with continuous high fever, we suggest oral stress dose cover with 20 mg hydrocortisone every 6 h. We also comment on suggested dosing for patients who usually take modified release hydrocortisone or prednisolone. In patients with adrenal insufficiency showing clinical deterioration during an acute COVID-19 infection, we advise immediate (self-)injection of 100 mg hydrocortisone intramuscularly, followed by continuous i.v. infusion of 200 mg hydrocortisone per 24 h, or until this can be established, and administration of 50 mg hydrocortisone every 6 h. We also advise on doses for infants and children.
Highlights
This guidance has been drawn up to inform clinicians and healthcare staff in their quest to provide guidance on the optimal management of patients with adrenal insufficiency under the circumstances of an acute global healthcare capacity crisis due to COVID-19, the viral illness caused by the novel corona virus SARS-CoV-2
Patients with adrenal insufficiency are at increased risk of COVID-19; they are at an increased risk of catching this infection and they have a higher risk of complications due to the potential for an adrenal crisis to be triggered by the infection
There is currently no evidence, suggestive of a higher likelihood of a severe course of disease in patients with AI falling ill with COVID-19
Summary
This guidance has been drawn up to inform clinicians and healthcare staff in their quest to provide guidance on the optimal management of patients with adrenal insufficiency under the circumstances of an acute global healthcare capacity crisis due to COVID-19, the viral illness caused by the novel corona virus SARS-CoV-2. Ensure that all patients (and their families/partners/ carers) are educated in the use of ‘the sick day rules’, that is, the need to increase their usual glucocorticoid replacement dose during intercurrent illness and the need to self-inject hydrocortisone and call for emergency medical assistance when the oral medication cannot be reliably absorbed due to vomiting or diarrhoea and/or the presence of severe and major illness or trauma.
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