Adrenal insufficiencies & COVID-19

The adrenal cortex produces hormones (glucocorticoids, mineralocorticoids, and androgens), which are necessary for normal body functioning. When the adrenal cortex is damaged, enough glucocorticoids and mineralocorticoids are not produced leading to deficiencies of these hormones.   

Adrenal Insufficiencies are classified into primary, secondary, and tertiary causes. Primary adrenal insufficiency, also known as Addison’s disease, is characterized by decreased aldosterone and cortisol production as a result of decreased gland function. This autoimmune disease occurs due to a patient’s own antibodies mistakenly attacking various adrenal cortex enzymes and can occur acutely or chronically. When this presents acutely, otherwise known as an adrenal crisis, patients may experience light-headedness or dizziness, weakness, sweating, abdominal pain, nausea, and vomiting, or even loss of consciousness and is considered a medical emergency. Adrenal crisis’ risk factors include physical stress such as infection, dehydration, trauma, or surgery, adrenal gland or pituitary gland injury, and ending treatment with steroids such as prednisone or hydrocortisone too early. Addison’s Disease and adrenal crises are treated with glucocorticoid replacements, most commonly corticosteroids. 

With the COVID-19 pandemic, many of the same corticosteroids are used to treat COVID-19 patients, leading to shortages with these medications. The Canadian Addison’s Society has stated that individuals with adrenal insufficiencies do not have a higher chance of COVID-19 infection but if they are infected, they should follow the guidelines for stress management while seeking medical attention. Health Canada has also recommended that if oral, IV, and/or inhaled steroids are indicated for non-COVID-19 reasons (for example, asthma or COPD exacerbation, or stress dosing in someone on chronic steroids or with known adrenal insufficiency), they should NOT be avoided. 

Guidelines and resources

The Society of Endocrinology’s clinical guidelines Regarding Adrenal Crisis during the COVID-19 pandemic can be found here

Canadian clinical guidelines regarding Diagnosis and Treatment of Primary Adrenal Insufficiency can be found here.  

Health Canada’s recommendations on clinical management of patients with COVID-19 can be found here

The Canadian Addison Society resources can be found here

A Corticosteroid equivalent dosing table can be found here