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Endocrinology in the time of COVID-19: Management of adrenal insufficiency

Lookup NU author(s): Professor Simon PearceORCiD



This is the authors' accepted manuscript of an article that has been published in its final definitive form by BioScientifica, 2020.

For re-use rights please refer to the publisher's terms and conditions.


We provide guidance on prevention of adrenal crisis during the global COVID-19 crisis, which exposes patients with adrenal insufficiency to an increased risk of acute COVID-19 infection while at the same time restricting access to healthcare due to capacity issues. We highlight the need for education (sick day rules, stringent social distancing rules), equipment (sufficient glucocorticoid supplies, steroid emergency self-injection kit) and empowerment (steroid emergency card, COVID-19 guidelines) to prevent adrenal crises. In patients with adrenal insufficiency developing an acute COVID-19 infection, which frequently presents with continuous high fever, we suggest oral stress dose cover with 20mg hydrocortisone every six hours. We also comment on suggested dosing for patients who usually take modified release hydrocortisone or prednisolone. In patients with clinical insufficiency showing clinical deterioration during an acute COVID-19 infection, we advise immediate (self-)injection of 100mg hydrocortisone intramuscularly, followed by continuous intravenous infusion of 200mg hydrocortisone per 24 hours, or until this can be established, administration of 50mg hydrocortisone every 6 hours.

Publication metadata

Author(s): Arlt W, Baldeweg SE, Pearce SHS, Simpson HL

Publication type: Article

Publication status: Published

Journal: European Journal of Endocrinology

Year: 2020

Volume: 183

Issue: 1

Pages: G25–G32

Print publication date: 01/07/2020

Online publication date: 01/07/2020

Acceptance date: 20/04/2020

Date deposited: 18/06/2020

ISSN (print): 0804-4643

ISSN (electronic): 1479-683X

Publisher: BioScientifica


DOI: 10.1530/EJE-20-0361

PubMed id: 32379699


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