No Increased COVID-19 Risk With Adequately Treated Adrenal Insufficiency

COVID-19

Adults with adrenal insufficiency who are adequately treated and trained display the same incidence of COVID-19-suggestive symptoms and disease severity as controls, according to a presenter.

“Adrenal insufficiency is supposed to be associated with an increased risk for infections and complications,” Giulia Carosi, a doctoral student in the department of experimental medicine at Sapienza University of Rome, said during a presentation at the virtual European Congress of Endocrinology Annual Meeting. “Our aim was to evaluate the incidence of COVID symptoms and related complications in this group.”

In a retrospective, case-control study, Carosi and colleagues evaluated the incidence of COVID-19 symptoms and complications among 279 adults with primary or secondary adrenal insufficiency (mean age, 57 years; 49.8% women) and 112 adults with benign pituitary nonfunctioning lesions without hormonal alterations, who served as controls (mean age, 58 years; 52.7% women). All participants lived in the Lombardy region of northern Italy. Participants completed a standardized questionnaire by phone on COVID-19-suggestive symptoms, such as fever, cough, myalgia, fatigue, dyspnea, gastrointestinal symptoms, conjunctivitis, loss of smell, loss of taste, upper respiratory tract symptoms, thoracic pain, headaches and ear pain. Patients with primary or secondary adrenal insufficiency were previously trained to modify their glucocorticoid replacement therapy when appropriate.

From February through April, the prevalence of participants reporting at least one symptom of viral infection was similar between the adrenal insufficiency group and controls (24% vs. 22.3%; P = .788).

Researchers observed “highly suggestive” symptoms among 12.5% of participants in both groups.

No participant required hospitalization and no adrenal crisis was reported. Replacement therapy was correctly increased for about 30% of symptomatic participants with adrenal insufficiency.

Carosi noted that few nasopharyngeal swabs were performed (n = 12), limiting conclusions on the exact infection rate (positive result in 0.7% among participants with adrenal insufficiency and 0% of controls; P = .515).

“We can conclude that hypoadrenal patients who have regular follow-up and trained about risks for infection and sick day rules seem to present the same incidence of COVID-19 symptoms and the same disease severity as controls,” Carosi said.

As Healio previously reported, there is no evidence that COVID-19 has a more severe course among individuals with primary and secondary adrenal insufficiency; however, those with adrenal insufficiency are at increased risk for respiratory and viral infections, and patients experiencing major inflammation and fever are at risk for life-threatening adrenal crisis. In a position statement issued by the American Association of Clinical Endocrinologists in March, researchers wrote that people with adrenal insufficiency or uncontrolled Cushing’s syndrome should continue to take their medications as prescribed and ensure they have appropriate supplies for oral and injectable steroids at home, with a 90-day preparation recommended. In the event of acute illness, those with adrenal insufficiency are instructed to increase their hydrocortisone dose per instructions and call their health care provider for more details. Standard “sick day” rules for increasing oral glucocorticoids or injectables would also apply, according to the statement.

From https://www.healio.com/news/endocrinology/20200910/no-increased-covid19-risk-with-adequately-treated-adrenal-insufficiency

Monday – Four Weeks Post-Op

This is the first of the timeline posts that I’m actually writing more or less as they happen!

day-mon

Last Monday, Feb 18 was the first visit with the cardiologist.  Getting there was a bit of a problem but the appointment itself went smoothly.

We got into the inner sanctum and a very nice nurse named Lisa took down DH’s info.  It worked out well that we hadn’t finished all the paperwork since she had lots of info fron the hospital, anyway.

She took DH’s blood pressure and oxygen levels (both good), then took the bags of meds and vitamins away for cataloging.

The doctor came in and asked some of the same questions as everyone else about how he was eating, sleeping, exercise, swelling, pain.  He listened to DH’s heart and lungs and everything sounded good.  He checked the legs for swelling…none.

We made 2 more appointments – one for a low-stress treadmill next week and one with him for three months out.  There’s also bloodwork to be done before the treadmill. After passing the treadmill test, DH can start rehab.  Yea!

When we got home, there was a call from the PCP’s lab.  DH called back but had just missed them.

day-tues
DH slept in the bed and out of the recliner for several hours last night.  Another step forward!

DH finally got through to the PCP’s lab and the cholesterol numbers were excellent.  Hooray!  Other numbers such as liver enzymes were good, too.

day-wed
DH did some work today, with several naps in between. I got the car taken care of. He got the disher unloaded and reloaded – with resting afterwards.

He decided to start off the night sleeping in bed and made it until about 4:00 am. He said that there was no pain but he would be more comfortable in the recliner.
day-thurs
DH spent most of the morning working (at home) on a proposal, then most of the afternoon napping.  Most of the pain seems gone – hooray! Evening there was a short meeting with a nap before and after.  Then, dinner and another nap before bed.

He started out for about an hour in bed, then back to the recliner for the rest of the night.

He doesn’t seem to cough nearly as much. Hooray!

day-fri

Friday through Sunday – lots of napping, trying to sleep or nap in the bed but usually winding up in the recliner.

day-sun

 

It was a nice day so we took the dog outside for a very short walk…followed by more napping.  DH is looking forward to the treadmill test on Wednesday so he can start the rehab soon.

Two Weeks After CABG

Sounds like a fairy tale of some kind involving veggies like cabbage, lettuce and other greenery.  But it’s not.  CABG is the abbreviation for Coronary artery bypass grafting, something I had no idea about 2 weeks ago.

CABG

DH had 3 of those grafts, the mammary artery and 2 from his leg vein.

From NIH:

Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD).

CHD is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina< (an-JI-nuh or AN-juh-nuh).

If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.

CABG is one treatment for CHD. During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle.

Surgeons can bypass multiple coronary arteries during one surgery.

I have to say it’s amazing how quickly the body can begin to heal after such an assault.  So far, we’ve seen the surgeon’s nurse practitioner and the visiting nurse.  Both say he’s doing very well for such a short amount of time.

There’s still some pain, some coughing, and other inconveniences but it’s amazing what modern medicine can do!