Impact of COVID-19 Pandemic on Psychophysical Stress in Patients with Adrenal Insufficiency: The CORTI-COVID Study

Abstract

Background: COVID-19 is a novel threat to patients with adrenal insufficiency (AI), whose life expectancy and quality (QoL) are impaired by increased risk of infections and stress-triggered adrenal crises (AC). If infected, AI patients require prompt replacement tailoring. We interviewed a cohort of AI patients assessing: COVID-19 prevalence and clinical presentation; prevalence of AC and association with intercurrent COVID-19 or pandemic-related psychophysical stress; lockdown-induced emotional burden, and health-related QoL. Methods: In this monocentric (Ancona University Hospital, Italy), cross-sectional study covering February-April 2020, 121 (40 primary, 81 secondary) AI patients completed telematically the following three questionnaires: purpose-built “CORTI-COVID”, assessing medical history and concern for COVID-19-related global health, AI-specific personal health, occupational, economic, and social consequences; AddiQoL-30; Short-Form-36 (SF-36) Health Survey. Findings: COVID-19 occurred in one (0·8% prevalence) 48-year-old woman with primary AI, who promptly tailored her replacement. Dyspnea lasted three days, without requiring hospitalization. Secondary AI patients were not involved. No AC were experienced, but pandemic-related stress accounted for 6/14 glucocorticoid up-titrations. Mean CORTI-COVID was similar between groups, mainly depending on “personal health” in primary AI (ρ=0·888, p<0·0001) and “economy” in secondary AI (ρ=0·854, p<0·0001). Working restrictions increased occupational concern. CORTI-COVID correlated inversely with QoL. AddiQoL-30 and SF-36 correlated strongly. Comorbidities worsened patients’ QoL. Interpretation: If educational efforts are made in preventing acute events, AI patients seem not particularly susceptible to COVID-19. The novel “CORTI-COVID” questionnaire reliably assesses the pandemic-related emotional burden in AI. Even under unconventional stress, educated AI patients preserve a good QoL. Funding: The authors received no funding. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was conducted according to the Declaration of Helsinki and approved by local Ethic Committee.