Significant Risk of COVID-19 and Related-hospitalization Among Patients with Adrenal Insufficiency: A Large Multinational Survey

Objective: To determine self-reported incidence and potential risk factors for COVID-19 in patients with adrenal insufficiency (AI).

Methods: A 27-item AI survey was developed for AI and COVID-19 status, vetted by specialists and patients, and distributed social media, websites, and advocacy groups. Participation was voluntary and anonymous. Data were collected from September 20, 2020 until December 31, 2020.

Results: Respondents (n=1291) with self-reported glucocorticoid treatment for AI, completed the survey, with 456 who reported having symptoms and were screened for COVID-19 during 2020; 40 tested positive (+ve), representing an 8.8% incidence. Of the COVID-19, 31 were female (78%), with mean age of 39.9 years. COVID-19 among AI patients occurred most commonly in those aged 40-59 years (n=17; 42.5%); mean time since AI diagnosis was 13.5 years (range 0.2-42.0 years). Pulmonary disease, congenital adrenal hyperplasia, and higher maintenance doses of glucocorticoids were significantly associated with +ve COVID-19 (=0.04, =0.01, and =0.001, respectively. In respondents the cumulative incidence of COVID-19 during 2020 was 3.1%; greater than the 1.03% worldwide-incidence reported by WHO, by December 31, 2020. There was a 3-fold (95% CI 2.16-3.98) greater relative risk (RR) of COVID-19 infection and a 23.8- fold (95% CI 20.7-31.2) RR of hospitalization in patients with AI, compared with the global population.

Conclusion: A markedly raised RR of COVID-19 and hospitalization in respondents reporting chronic AI was detected. We found that a diagnosis of congenital adrenal hyperplasia, age>40 years, male gender, pulmonary disease, and higher maintenance doses of glucocorticoids were associated with greatest risk.