COVID-19 :New UK steroid guidance issued
Advice for patients who take replacement steroids (hydrocortisone, prednisolone, dexamethasone or plenadren) for pituitary/adrenal insufficiency.
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The World Health Organization has declared the Coronavirus outbreak to be a public health emergency of international concern. In response, the UK Chief Medical Officers have raised the risk to the public.
If you have adrenal insufficiency (steroid dependent) and you become unwell for any reason, it’s important that you follow sick day rules. This means in the first instance that you double your usual doses of glucocorticoid replacement.
The term adrenal insufficiency includes Addison’s disease with primary adrenal failure, patients with pituitary problem including secondary adrenal failure and patients with congenital adrenal hyperplasia.
The government has recently recommended that those at increased risk of severe illness from coronavirus should be particular stringent in following social distancing measures. On the basis of current data, there is no evidence that patients with adrenal insufficiency are at increased risk of contracting COVID-19. However, we know that patients with Addison’s disease (primary adrenal insufficiency) and congenital adrenal hyperplasia have a slightly increased overall risk of catching infections. In addition, patients with adrenal insufficiency would require additional measures when severely unwell (hydrocortisone injection and infusion) to avoid an adrenal crisis.
The recently published list of people considered vulnerable includes anyone instructed to get a flu jab as an adult each year on medical grounds as well as all people whose medication includes steroid tablets. Whilst adrenal insufficiency is not specifically mentioned in this guidance, both of these criteria apply to patients with adrenal insufficiency. Patients with adrenal insufficiency are recommended to have flu vaccinations, as this would not only prevent illness from the flu itself but also reduce complications arising from managing the adrenal insufficiency during severe illness. We would therefore consider patients with adrenal insufficiency part of the group of vulnerable individuals who should, therefore, be particular stringent in following social distancing measures.