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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.
Author(s): Arlt W, Baldeweg SE, Pearce SHS, Simpson HL
Publication type: Article
Publication status: Published
Journal: European Journal of Endocrinology
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
PubMed id: 32379699
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