ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency.

Arlt, Wiebke, Baldeweg, Stephanie E, Pearce, Simon H S and Simpson, Helen L (2020) ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency. European journal of endocrinology, 183 (1). G25-G32. ISSN 1479-683X.

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Official URL: https://eje.bioscientifica.com/

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.

Item Type: Article
Subjects: WC Communicabable diseases
WF Respiratory system. Respiratory medicine
WK Endocrine system. Endocrinology
Divisions: Ambulatory Care > Endocrinology
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Depositing User: Jamie Edgar
Date Deposited: 08 Jul 2020 10:47
Last Modified: 08 Jul 2020 10:47
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3233

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