Adrenal Insufficiency at the Time of COVID-19: A Retrospective Study in Patients Referring to a Tertiary Center

J Clin Endocrinol Metab. 2021 Mar 8;106(3):e1354-e1361. doi: 10.1210/clinem/dgaa793.


Context: Coronavirus disease 2019 (COVID-19) represents a global health emergency, and infected patients with chronic diseases often present with a severe impairment. Adrenal insufficiency (AI) is supposed to be associated with an increased infection risk, which could trigger an adrenal crisis.

Objective: Our primary aim was to evaluate the incidence of COVID-19 symptoms and complications in AI patients.

Design and setting: We conducted a retrospective case-control study. All patients were on active follow-up and lived in Lombardy, Italy, one of the most affected areas.

Patients: We enrolled 279 patients with primary and secondary AI and 112 controls (patients with benign pituitary lesions without hormonal alterations). All AI patients had been previously trained to modify their replacement therapy on stress doses.

Intervention: By administering a standardized questionnaire by phone, we collected data on COVID-19 suggestive symptoms and consequences.

Results: In February through April 2020, the prevalence of symptomatic patients (complaining at least 1 symptom of viral infection) was similar between the 2 groups (24% in AI and 22.3% in controls, P = 0.79). Highly suggestive COVID-19 symptoms (at least 2 including fever and/or cough) also occurred equally in AI and controls (12.5% in both groups). No patient required hospitalization and no adrenal crisis was reported. Few nasopharyngeal swabs were performed (n = 12), as indicated by sanitary regulations, limiting conclusions on the exact infection rate (2 positive results in AI and none in controls, P = 0.52).

Conclusions: AI patients who are adequately treated and trained seem to display the same incidence of COVID-19-suggestive symptoms and disease severity as controls.

Keywords: COVID-19; adrenal insufficiency; hypopituitarism; infectious diseases.

Publication types

  • Observational Study

MeSH terms

  • Adrenal Insufficiency / complications
  • Adrenal Insufficiency / diagnosis
  • Adrenal Insufficiency / epidemiology*
  • Adrenal Insufficiency / therapy
  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 / complications*
  • COVID-19 / diagnosis
  • COVID-19 / epidemiology*
  • COVID-19 / therapy
  • Case-Control Studies
  • Female
  • Humans
  • Hypopituitarism / complications
  • Hypopituitarism / diagnosis
  • Hypopituitarism / epidemiology
  • Hypopituitarism / therapy
  • Incidence
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2 / physiology
  • Severity of Illness Index
  • Tertiary Care Centers / statistics & numerical data
  • Young Adult