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Eur J Endocrinol ; 183(1): G1-G7, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-256412


Clinical evaluation should guide those needing immediate investigation. Strict adherence to COVID-19 protection measures is necessary. Alternative ways of consultations (telephone, video) should be used. Early discussion with regional/national experts about investigation and management of potential and existing patients is strongly encouraged. Patients with moderate or severe clinical features need urgent investigation and management. Patients with active Cushing's syndrome, especially when severe, are immunocompromised and vigorous adherence to the principles of social isolation is recommended. In patients with mild features or in whom a diagnosis is less likely, clinical re-evaluation should be repeated at 3 and 6 months or deferred until the prevalence of SARS-CoV-2 has significantly decreased; however, those individuals should be encouraged to maintain social distancing. Diagnostic pathways may need to be very different from usual recommendations in order to reduce possible exposure to SARS-CoV-2. When extensive differential diagnostic testing and/or surgery is not feasible, it should be deferred and medical treatment should be initiated. Transsphenoidal pituitary surgery should be delayed during high SARS-CoV-2 viral prevalence. Medical management rather than surgery will be the used for most patients, since the short- to mid-term prognosis depends in most cases on hypercortisolism rather than its cause; it should be initiated promptly to minimize the risk of infection in these immunosuppressed patients. The risk/benefit ratio of these recommendations will need re-evaluation every 2-3 months from April 2020 in each country (and possibly local areas) and will depend on the local health care structure and phase of pandemic.

Coronavirus Infections/prevention & control , Cushing Syndrome/therapy , Enzyme Inhibitors/therapeutic use , Glucocorticoids/therapeutic use , Infection Control/methods , Neurosurgical Procedures/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine , 14-alpha Demethylase Inhibitors/therapeutic use , ACTH-Secreting Pituitary Adenoma/complications , ACTH-Secreting Pituitary Adenoma/diagnosis , ACTH-Secreting Pituitary Adenoma/therapy , Adenoma/complications , Adenoma/diagnosis , Adenoma/therapy , COVID-19 , Coronavirus Infections/transmission , Cushing Syndrome/diagnosis , Cushing Syndrome/etiology , Cushing Syndrome/immunology , Disease Management , Humans , Hydrocortisone/blood , Immunocompromised Host , Ketoconazole/therapeutic use , Metyrapone/therapeutic use , Patient Education as Topic , Pneumonia, Viral/transmission , Practice Guidelines as Topic , Severity of Illness Index , Time Factors
Eur J Endocrinol ; 183(1): G17-G23, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-205229


Patients with pituitary tumours, ensuing hormonal abnormalities and mass effects are usually followed in multidisciplinary pituitary clinics and can represent a management challenge even during the times of non-pandemic. The COVID-19 pandemic has put on hold routine medical care for hundreds of millions of patients around the globe, while many pituitary patients' evaluations cannot be delayed for too long. Furthermore, the majority of patients with pituitary tumours have co-morbidities potentially impacting the course and management of COVID-19 (e.g. hypopituitarism, diabetes mellitus, hypertension, obesity and cardiovascular disease). Here, we summarize some of the diagnostic and management dilemmas encountered, and provide guidance on safe and as effective as possible delivery of care in the COVID-19 era. We also attempt to address how pituitary services should be remodelled in the event of similar crises, while maintaining or even improving patient outcomes. Regular review of these recommendations and further adjustments are needed, depending on the evolution of the COVID-19 pandemic status. We consider that the utilization of successful models of pituitary multidisciplinary care implemented during the COVID-19 pandemic should continue after the crisis is over by using the valuable and exceptional experience gained during these challenging times.

Adenoma/therapy , Antineoplastic Agents, Hormonal/therapeutic use , Coronavirus Infections , Dopamine Agonists/therapeutic use , Neurosurgical Procedures , Pandemics , Pituitary Apoplexy/therapy , Pituitary Neoplasms/therapy , Pneumonia, Viral , Adenoma/diagnosis , COVID-19 , Cabergoline/therapeutic use , Disease Management , Hormone Replacement Therapy , Human Growth Hormone/analogs & derivatives , Human Growth Hormone/therapeutic use , Humans , Octreotide/therapeutic use , Peptides, Cyclic/therapeutic use , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/diagnosis , Practice Guidelines as Topic , Radiotherapy , Somatostatin/analogs & derivatives , Somatostatin/therapeutic use , Telemedicine , Time Factors , Visual Field Tests