Adrenal insufficiency is a medical condition that occurs when the adrenal glands located just above the kidneys, don’t make enough of the ‘stress hormone’ cortisol due to a central or glandular issue. Among other functions, cortisol regulates our immune response. Children with adrenal insufficiency are unable to mount a normal stress response to infections.
A new unpublished study presented at the virtual conference ENDO2021, the Endocrine Society’s annual meeting, titled ” Risk of Complications in Children With Adrenal Insufficiency and Covid-19” shows children with adrenal insufficiency are at higher risk for COVID-19 complications and death compared to children with normally functioning adrenal glands.
“Adrenal insufficiency may put a person at higher risk of infections due to a lack of normal stress response by the body,” says lead researcher Manish Raisingani, MD, assistant professor at the Department of Pediatrics at the University of Arkansas for Medical Sciences. “Until now, there has been limited data on children with adrenal insufficiency and COVID-19.”
The primary form of adrenal insufficiency is also called Addison’s disease. Cortisol helps break down fats, proteins, and carbohydrates. It also regulates blood pressure and affects the immune system. Children suffering from adrenal insufficiency are treated with daily cortisol replacement therapy. When children with adrenal insufficiency get sick, they need higher doses of cortisol.
For this study, the researchers used TriNetX, that incorporates a large COVID-19 database that collects real-time electronic medical records from 54 health care organizations. Raisingani and his team compared children who were diagnosed with COVID-19, with and without a concurrent diagnosis of adrenal insufficiency. All children with adrenal insufficiency included in the study and the healthy controls were between the ages of 0 and 18 years. The study included a total of 846 children with adrenal insufficiency and more than 250,000 without adrenal insufficiency as control subjects.
The mortality rate was much higher among children who had adrenal insufficiency, compared to children who did not have the condition. Mortality rate in children with COVID-19 and adrenal insufficiency was 2.246% (19 of 846 children) whereas mortality rate in children with COVID-19 without adrenal insufficiency was 0.097 % (244 of 252211 children). This indicates the relative risk of death for children with COVID-19 and adrenal insufficiency is almost 23 times higher than children with COVID-19 but without adrenal insufficiency.
“This study shows it is important to take extra precautions to prevent and treat COVID-19 infection in children with adrenal insufficiency,” says Raisingani.
The authors also compared other complications associated with COVID-19 such as the rate of inserting a tube in the airway of patients to ease breathing (endotracheal intubation) in children suffering from COVID-19 with and without adrenal insufficiency. Whereas 12 in 846 patients (1.418%) with COVID-19 and adrenal insufficiency were administered endotracheal intubation, only 165 of 252211 patients (0.065%) with COVID-19 but without adrenal insufficiency were administered endotracheal intubation. This indicated that the relative risk of endotracheal intubation for children with COVID-19 and adrenal insufficiency was 21.68.
Sepsis, a life-threatening medical emergency constitutes the body’s extreme response to infection. It involves increased heart rate, decreased blood pressure, fever, chills, shortness of breath, profuse sweating and extreme pain. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.
The researchers compared the rates of sepsis in children with COVID-19 with and without adrenal insufficiency. In children with COVID-19 and adrenal insufficiency, sepsis rate was 6.974% (59 of 846 patients) while in children with COVID-19 without adrenal insufficiency, sepsis rate was 0.274% (691 of 252211 patients). This shows that the relative risk of sepsis in children with COVID-19 and adrenal insufficiency was 25.45.
The authors conclude that as mortality rate, endotracheal intubation and sepsis showed significantly increased association in children with adrenal insufficiency and COVID-19 compared to children with COVID-19 and no adrenal insufficiency extra measures must be taken to avoid dire consequences in children with adrenal insufficiency who are suffering from COVID-19.
“One limitation of the study is that we did not distinguish between primary and secondary adrenal insufficiency,” says Raisingani. Further studies with larger sample size are needed to study complication rates of COVID-19 and adrenal insufficiency.
