SAT283 The Incidence Of Worsening Symptoms Of Adrenal Insufficiency And COVID-19 Infection After Receiving COVID-19 Vaccine In Patients With Adrenal Insufficiency: A Survey-based Study

Disclosure: K. Al Sibai: None. M.D. Lundholm: None. N. Nachawi: None. J. Baikovitz: None. J. Bena: None. M. Lansang: None. Introduction: There is uncertainty if COVID-19 vaccine administration can induce enough stress to precipitate worsening of adrenal insufficiency (AI) or even adrenal crisis. The aim of the study is to evaluate the incidence of worsening symptoms of AI after receiving the COVID-19 vaccine in patients with AI. Methods: This is a single-center survey study of patients with either primary or secondary AI by ICD code in our electronic medical record. Diagnoses were confirmed with chart review and patients were included if on stable physiologic glucocorticoid replacement doses for at least 3 months prior to COVID-19 vaccination. These patients were sent a survey asking about the date/type of vaccine, the occurrence of AI symptoms, and if they took a higher dose of oral GC, or took injectable GC, or sought a higher level of medical care. Results: There were 340 eligible patients, and 61 patients to date have completed the survey (18% response rate). Responders were 64% female, 41% with primary AI, and 56% with secondary AI. The median age was 57 (IQR 50, 68) years with a median hydrocortisone-equivalent replacement dose used of 20 (IQR 20, 25) mg daily. Each vaccination was treated as a separate event. A total of 194 COVID vaccination events were recorded, which included 35 (18%) vaccination events when higher doses of GC were used, 35% of which were after onset of symptoms. Mild AI symptoms, i.e., fever, weakness, nausea/vomiting, diarrhea, and dizziness, body aches, and weakness occurred in 62% of events. The most reported symptoms were body aches and weakness (48% and 35% respectively). Severe AI symptoms, i.e., low blood pressure and fainting, occurred in 4.6% of events. The need to use injectable GC, seeking medical care or ED visits occurred in 5.7%. There was no significant difference in seeking medical care nor using injectable GC for patients who took stress dose GC vs those who did not (OR 0.69, 95% CI 0.10,4.88, p=0.7). Conclusion: At present analysis, the incidence of worsening AI-related symptoms was high after COVID-19 vaccination (62%). Most reported symptoms were mild and self-limited that did not require a higher level of medical care. About 6% of survey takers used injectable GC or sought a higher level of care. Our preliminary results do not support routine prophylactic stress-dose GC for receiving COVID-19 vaccines in patients with AI. We estimate another 100 patients to complete our survey. Presentation: Saturday, June 17, 2023