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Survey of glucocorticoid dose escalation in patients with adrenal insufficiency during the peri-COVID-19 vaccination period.
Bando, Hironori; Yamamoto, Masaaki; Takahashi, Michiko; Kanie, Keitaro; Sasaki, Yuriko; Oi, Yuka; Tomofuji, Seiji; Hozumi, Kaori; Nishikage, Seiji; Urai, Shin; Yamamoto, Naoki; Suzuki, Masaki; Shichi, Hiroki; Iguchi, Genzo; Fukuoka, Hidenori; Ogawa, Wataru.
  • Bando H; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan.
  • Yamamoto M; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan.
  • Takahashi M; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan.
  • Kanie K; Department of Nutrition, Kobe University Hospital, Kobe, Japan.
  • Sasaki Y; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan.
  • Oi Y; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan.
  • Tomofuji S; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University School of Medicine, Kobe, Japan.
  • Hozumi K; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan.
  • Nishikage S; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University School of Medicine, Kobe, Japan.
  • Urai S; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan.
  • Yamamoto N; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University School of Medicine, Kobe, Japan.
  • Suzuki M; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University School of Medicine, Kobe, Japan.
  • Shichi H; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University School of Medicine, Kobe, Japan.
  • Iguchi G; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University School of Medicine, Kobe, Japan.
  • Fukuoka H; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University School of Medicine, Kobe, Japan.
  • Ogawa W; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University School of Medicine, Kobe, Japan.
Endocr J ; 2022 Sep 15.
Article in English | MEDLINE | ID: covidwho-2227896
ABSTRACT
There is uncertainty regarding the need for COVID-19 peri-vaccination glucocorticoid coverage in patients with adrenal insufficiency. In this survey conducted in a single tertiary medical institution, 167 consecutive outpatients taking physiological glucocorticoids because of adrenal insufficiency were included. The patients declared if they developed an adrenal crisis after vaccination, and the amount and duration of an increase in their glucocorticoid dosage, if any. None of the patients without preventive glucocorticoid increase suffered an adrenal crisis after COVID-19 vaccination. Only 8.3% (14 cases) and 27.5% (46 cases) of the patients needed to escalate the dose of glucocorticoids when systemic symptoms appeared after the first and second injections, respectively. Glucocorticoids were increased in patients <60 years of age more than in patients ≥60 years of age at the time of both the first (p = 0.026) and second injections (p = 0.005). Sex and the causes of adrenal insufficiency were not associated with the frequency of the patients who needed glucocorticoid dose escalation. In the cases with increased glucocorticoids, the median dosage for escalation was 10 mg (hydrocortisone equivalent). In conclusion, even without prophylactic glucocorticoid administration, adrenal crisis did not occur during the peri-COVID-19 vaccination period. The dose escalation of steroid was more frequent in younger patients following the second vaccination. Careful monitoring of adverse effects and the appropriate management of glucocorticoids when necessary are essential following COVID-19 vaccinations.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study Topics: Vaccines Language: English Journal subject: Endocrinology Year: 2022 Document Type: Article Affiliation country: Endocrj.EJ22-0390

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study Topics: Vaccines Language: English Journal subject: Endocrinology Year: 2022 Document Type: Article Affiliation country: Endocrj.EJ22-0390