adrenal insufficiency and the coronavirus

March 10, 2020

We’ve become aware of a study in the European Journal of Endocrinology. This is an important study and have an updated response from NADF Medical Director Paul Margulies, MD, FACE, FACP.

When I responded to the question about adrenal insufficiency and the coronavirus I wanted to distinguish between the autoimmunity of Addison’s disease from the immunity from infectious diseases because this often causes confusion.

• The study sited does suggest for the first time that there may be a defect in the natural killer cell function that could make individuals with adrenal insufficiency more susceptible to viral infections.
• From the data in the paper, it is clear that this is a glucocorticoid affect rather than a defect stemming from the autoimmune etiology of Addison’s, since it appeared in individuals with surgical adrenal insufficiency.
• It is also noteworthy that there was no significant difference in neutrophil function responsible for fighting bacterial infections.
• The authors suggest that the diurnal timing of steroid hormone therapy may have a role in the killer cell dysfunction and have an increased risk of acquiring viral infections, not just an increased risk of suffering more serious consequences.

What does this mean for AI patients?
Individuals with all types of adrenal insufficiency, both primary and secondary Adrenal Insufficiency, should exercise extra precautions, and follow the CDC recommendations for individuals at higher risk. 
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html