Impact of COVID-19 on patients with primary adrenal insufficiency : a cross-sectional study
Knowles, Gregory Warmington, Emily Shepherd, Lisa M Hazlehurst, Jonathan M de Bray, Anne Gleeson, Helena Arlt, Wiebke Prete, Alessandro
Knowles, Gregory
Warmington, Emily
Shepherd, Lisa M
Hazlehurst, Jonathan M
de Bray, Anne
Gleeson, Helena
Arlt, Wiebke
Prete, Alessandro
Citations
Altmetric:
Affiliation
Walsall Healthcare NHS Trust; University of Birmingham; University Hospitals Birmingham NHS Foundation Trust; Medical Research Council London Institute of Medical Sciences
Other Contributors
Publication date
2023-07-12
Subject
Research Projects
Organizational Units
Journal Issue
Abstract
Objective: Patients with primary adrenal insufficiency (PAI) are thought to be particularly vulnerable to COVID-19; however, little is known about its true impact on this group. We assessed morbidity and health promotion attitudes during the pandemic amongst a large cohort of patients with PAI.
Design: Cross-sectional, single-centre study.
Methods: In May 2020, COVID-19 advice on social distancing and sick-day rules was distributed to all patients with PAI registered with a large secondary/tertiary care centre. A semi-structured questionnaire was used to survey patients in early 2021.
Results: Of 207 contacted patients, 162 responded (82/111 with Addison's disease, AD; 80/96 with congenital adrenal hyperplasia, CAH). Patients with AD were older than those with CAH (median age 51 vs. 39 years; p<0.001) and had more comorbidities (Charlson comorbidity index ≥2 47.6% vs. 10.0%; p<0.001). By the time of the survey, 47 patients (29.0%) had been diagnosed with COVID-19, the second commonest cause of sick-day dosing during the study and the leading trigger of adrenal crises (4/18 cases). Patients with CAH had a higher risk of COVID-19 compared to AD (adjusted odds ratio 2.53 [95% CI 1.07-6.16], p=0.036), were less inclined to have the COVID-19 vaccine (80.0% vs. 96.3%; p=0.001), and were less likely to have undergone hydrocortisone self-injection training (80.0% vs. 91.5%; p=0.044) or wear medical alert jewellery (36.3% vs. 64.6%; p=0.001).
Conclusions: COVID-19 was a principal trigger for adrenal crises and sick-day dosing in patients with PAI. Despite a higher risk of COVID-19, patients with CAH showed less engagement with self-protective attitudes.
Citation
Knowles G, Warmington E, Shepherd LM, Hazlehurst JM, de Bray A, Gleeson H, Arlt W, Prete A. Impact of coronavirus disease 2019 on patients with primary adrenal insufficiency: a cross-sectional study. Endocr Connect. 2023 Jul 12;12(8):e230122.
Type
Article