The endocrine system: steroids put patients at high risk for COVID-19

The endocrine system: steroids put patients at high risk for COVID-19
iStock-Iuliia Mikhalitskaia

Patients with endocrine system related diseases, and those who are taking a class of steroid medications called glucocorticoids, are at high risk for COVID-19.

The Journal of Clinical Endocrinology & Metabolism (JCEM) editors have examined the coronavirus pandemic’s impact on patients with endocrine system related diseases in a new editorial. They have concluded that individuals taking the steroid hormones for conditions such as asthma, allergies and arthritis, on a routine basis, are at higher risk if they become infected with the coronavirus, known as COVID-19.

The reason these patients are at high risk as it means they may be unable to mount a normal stress response, according to the new editorial published in JCEM.

Glucocorticoids are a class of medications used to treat a variety of inflammatory conditions and administered by many different routes, including tablets, topical creams and inhaled medications. The authors note that patients with Addison’s disease and those with secondary adrenal insufficiency should also take precautions.

Supplemental steroid medication therapy

Patients taking glucocorticoids may be more susceptible to COVID-19 as a result of the medication suppressing the immune system, and may also experience more severe disease once they are infected as these medications suppress their own steroid response to infection.

The authors say that injectable supplemental glucocorticoid therapy in this setting can reverse the risk of potentially fatal adrenal failure and should be considered in every case.

Adrenal insufficiency

According to the editorial, people who have Addison’s disease, a primary adrenal insufficiency, and patients who have secondary adrenal insufficiency, occurring in conditions such as hypopituitarism, should also take extra care. The authors note that people with these conditions who develop a fever continuous dry cough should double their glucocorticoid dose until the fever has subsided, and that injectable glucocorticoid therapy would also be needed should their condition worsen.

Endocrine-related diseases

According to the authors, among individuals with diabetes who contract COVID-19, the severity of the illness appears to be worse than in individuals who do not have diabetes. Published research from the Wuhan province in China found those with diabetes and high blood pressure were overrepresented among severely ill patients and those who died.

“In our professional lives, we have not witnessed a healthcare crisis of this magnitude and severity,” the authors wrote. “Endocrine-related targets are at the forefront of discovery science as we collectively tackle this pandemic”.

Scientists have already helped to uncover how the virus responsible for COVID-19 enters cells and spreads from one individual to another. Some have already made preliminary observations regarding the virus’ interactions with the endocrine system.

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