Individuals taking class of steroid medications at high risk for COVID-19

Individuals taking a class of steroid hormones called glucocorticoids for conditions such as asthma, allergies and arthritis on a routine basismay be unable to mount a normal stress response and are at high risk if they are infected with the virus causing COVID-19, according to a new editorial published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

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.Patients taking these medications may be more susceptible to COVID-19 as a result of the medication suppressing the immune system. They may also experience more severe disease once infected because these medications suppress their own steroid response to infection. Injectable supplemental glucocorticoid therapy in this setting can reverse the risk of potentially fatal adrenal failure and should be considered in every case.

Individuals with known primary adrenal insufficiency, also known as Addison’s disease, and secondary adrenal insufficiencyoccurring in hypopituitarism should also take extra precautions. If patients develop symptoms such as a dry continuous cough and fever, they should double their oral glucocorticoid dose immediately and continue doing so until the fever has subsided. They, too, will require injectable glucocorticoid therapy should their condition worsen.

Endocrinologists can play a key role in recognizing, managing and implementing these measures, according to the authors.

According to the World Health Organizations, there are more than 719,000 confirmed cases of COVID-19. More than 33,000 people have died from the disease as of March 31.

“In our professional lives, we have not witnessed a healthcare crisis of this magnitude and severity,” the authors wrote.

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, according to the authors. 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.

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.

“Endocrine-related targets are at the forefront of discovery science as we collectively tackle this pandemic,” the authors wrote.

The editorial’s authors include JCEM Editor-in-Chief Paul M. Stewart, M.D., F.R.C.P.; and Deputy Editors Ursula B. Kaiser, M.D., and Raghavendra G.Mirmira, M.D., Ph.D.

The editorial, “Our response to COVID-19 as endocrinologists and diabetologists,” was published online, ahead of print.