The Journal of Clinical Endocrinology & Metabolism: Our Response to COVID-19 as Endocrinologists and Diabetologists

In our professional lives, we have not witnessed a healthcare crisis of this magnitude and severity. As we proof this (March 30, 2020), COVID-19, caused by the SARS-CoV-2 virus and labeled a global pandemic by the World Health Organization, is sweeping across the globe For patients treated with glucocorticoids, it will be invaluable to reiterate “sick day rules” for our known patients with primary and secondary adrenal insufficiency taking glucocorticoid replacement therapy. As it relates to COVID-19, any patient with a dry continuous cough and fever should immediately double their daily oral glucocorticoid dose and continue on this regimen until the fever has subsided. Deteriorating patients and those who experience vomiting or diarrhea should seek urgent medical care and be treated with parenteral glucocorticoids. In the interim, it seems logical, if not essential, that we identify all patients taking corticosteroids for whatever reason as high risk. We know from the published reports to date that these patients will be overrepresented in those at greatest risk of dying from COVID-19—the elderly and those with co-morbidities that include diabetes, hypertension, and chronic inflammatory disease. Moreover, those patients taking supraphysiologic doses of glucocorticoids may have increased susceptibility to COVID-19 as a result of the immunosuppressive effects of steroids, comorbidities of underlying immune disorders for which the steroids were prescribed, or immunomodulatory actions of other therapies prescribed in conjunction with glucocorticoids for the underlying disease. Second, the impact on patients with pituitary or other neuroendocrine disease also needs to be considered. As for patients with primary adrenal insufficiency, many of these patients have hypopituitarism including secondary adrenal insufficiency, requiring stress dose glucocorticoid supplementation as previously noted. Moreover, these patients may also have diabetes insipidus, further compounding fluid and electrolyte disorders and requiring careful monitoring and judicious water and electrolyte replacement to prevent hyponatremia or hypernatremia. Third, for patients with diabetes mellitus, whereas the risk of contracting a viral illness is no greater than those without diabetes mellitus, severity of disease from viral infections is notably greater. Recent published reports from the Wuhan province in China (3,4) reveal that those with diabetes mellitus and hypertension were overrepresented among the most severely ill patients with COVID-19 and those succumbing to the disease. To read more-


Useful update and informative educative post. Something new is coming daily regarding source,mode of transmission , age group sign symptoms and treatment , endocrinologist role is important particularly in old age and chr disease pts because of low immunity or any other hormonal changes during COVID 19 infection.
Thanks Dr Vipin Bihari Jain

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Informative ....
Good information

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