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. 2020 Apr 1;EJE-20-0352.
doi: 10.1530/EJE-20-0352. Online ahead of print.

Endocrinology in the Time of COVID-19: Management of Cushing's Syndrome

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Endocrinology in the Time of COVID-19: Management of Cushing's Syndrome

John Newell-Price et al. Eur J Endocrinol. .

Abstract

• Clinical evaluation should guide those needing investigation • Strict adherence to COVID-19 protection measures is necessary • Alternative ways of consultations (telephone, video) should be used • Early discussion with regional/national experts about investigation and management of potential and existing patients is strongly encouraged • Patients with moderate and severe clinical features need urgent investigation and management • Patients with active Cushing's syndrome, especially when severe, are immunocompromised and social shielding is recommended • In patients with mild features or in whom a diagnosis is less likely, clinical re-evaluation should be repeated at three and six months or deferred until the prevalence of SARS-CoV-2 has significantly decreased • Diagnostic pathways may need to be very different from usual recommendations in order to reduce investigations • When extensive differential diagnostic testing is not feasible, it should be deferred, and medical treatment should be initiated • Transsphenoidal pituitary surgery may be avoided during high SARS-CoV-2 viral prevalence • Medical management rather than surgery will be the used for most patients since the short- to mid-term prognosis depends in most cases on hypercortisolism rather than its cause; it should be initiated promptly to minimize the risk of infection in these immunosuppressed patients.

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