Endocrinologists Called to Restrict Glucocorticoid Prescriptions to Aid in COVID-19 Crisis

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The article "How Endocrinologists Can Make an Impact During Coronavirus Crisis," was originally published on our partner site Contagion Live.

Individuals treated with glucocorticoids will be at higher risk for coronavirus disease 2019 (COVID-19), the infection caused by the novel coronavirus, according to an editorial published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Authors from the United States and United Kingdom outlined areas where their endocrinology specialty can contribute and be impactful during this crisis.

“We will all be in the midst of national and locally driven crisis management plans that understandably will impact our routine practice as we prioritize acute care to the most vulnerable,” they wrote.

Individuals may be taking glucocorticoids via tablets, topical creams or inhaled medications for a variety of reasons, including the treatment of asthma, allergies and arthritis. These patients may be at risk for COVID-19 as a result of their treatment which can suppress the immune system. Additionally, if infected with COVID-19, patients taking glucocorticoids may have a more severe course of disease, they wrote.

Endocrinologists may find it effective to reiterate “sick day rules,” meaning that they should inform patients who develop dry continuous cough and fever to double their daily oral glucocorticoid dose. This regimen should be continued until the fever has subsided, they instructed. Patients whose conditions deteriorate and subsequently experience vomiting or diarrhea should seek urgent care and be treated with parenteral glucocorticoids. (Contagion® has previously reported that gastrointestinal symptoms could be a sign of COVID-19.)

The editorialists further suggested that identifying all patients taking corticosteroids for whatever reason should be labeled high risk for COVID-19. Other reports suggest that these patients will be overrepresented among cohorts at the greatest risk from dying from the infection, they added.

It will also be important to explain the reason for the patient’s use of a glucocorticoid, the authors said. During previous epidemics of SARS and MERS, which are closely related to coronavirus, glucocorticoids did not demonstrate any benefit associated with higher relates of ventilation or mortality. During this crisis, the World Health Organization recommends against prescribing glucocorticoids, they wrote. Intravenous hydrocortisone, not pharmacological doses of other corticosteroids, should be given for physiological stress.

The authors also said that patients with diabetes, pituitary disease or other neuroendocrine diseases should be considered high risk for COVID-19. The risk for contracting a viral illness does not differ depending on diabetes status, the authors said, but disease severity has been notable greater for diabetic patients based on reports from the outbreak’s epicenter in Wuhan, China.

“Those with diabetes mellitus and hypertension were overrepresented among the most severely ill patients with COVID-19 and those succumbing to the disease,” the authors wrote, though they added it is uncertain at this time if that susceptibility is because of the severity of COVID-19 or the greater risk to diabetic patients themselves. “Current guidance from the [US] Centers for Disease Control and Prevention for prevention of COVID-19 for those with diabetes is no different than the general population, but the recognition that diabetes poses a greater risk for severity of illness should prompt health-care providers to be more vigilant in the assessment of such patients who present with concerning symptoms (ie, shortness of breath, fever).”
Endocrine-related targets are at the forefront of discovery science while the global community works to eradicate the coronavirus, the editorialists concluded.