Impact of COVID-19 on patients with primary adrenal insufficiency : a cross-sectional study

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.