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ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency
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; howev...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938015/ https://www.ncbi.nlm.nih.gov/pubmed/32379699 http://dx.doi.org/10.1530/EJE-20-0361 |
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author | Arlt, Wiebke Baldeweg, Stephanie E Pearce, Simon H S Simpson, Helen L |
author_facet | Arlt, Wiebke Baldeweg, Stephanie E Pearce, Simon H S Simpson, Helen L |
author_sort | Arlt, Wiebke |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7938015 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-79380152021-03-11 ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency Arlt, Wiebke Baldeweg, Stephanie E Pearce, Simon H S Simpson, Helen L Eur J Endocrinol Clinical Practice Guidance 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. Oxford University Press 2020-07-01 /pmc/articles/PMC7938015/ /pubmed/32379699 http://dx.doi.org/10.1530/EJE-20-0361 Text en © 2020 The authors https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by/4.0/), which permits non-commercial reuse, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Clinical Practice Guidance Arlt, Wiebke Baldeweg, Stephanie E Pearce, Simon H S Simpson, Helen L ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency |
title | ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency |
title_full | ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency |
title_fullStr | ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency |
title_full_unstemmed | ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency |
title_short | ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency |
title_sort | endocrinology in the time of covid-19: management of adrenal insufficiency |
topic | Clinical Practice Guidance |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938015/ https://www.ncbi.nlm.nih.gov/pubmed/32379699 http://dx.doi.org/10.1530/EJE-20-0361 |
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