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Practical Considerations for the Management of Cushing's Disease and COVID-19: A Case Report

Federica Beretta1, Francesca Dassie1, Matteo Parolin1

  • 1Clinica Medica 3, Department of Medicine, University of Padua, Padua, Italy.

Frontiers in Endocrinology
|October 19, 2020
PubMed

Insights

COVID-19 infection can cause adrenal insufficiency in Cushing's disease (CD) patients, requiring prompt treatment. Adjusting CD medications during COVID-19 is crucial for managing this complex interaction.

Area of Science:

  • Endocrinology
  • Infectious Diseases
  • Internal Medicine

Background:

  • The COVID-19 pandemic presents unique challenges for patients with complex endocrine disorders.
  • Cushing's disease (CD) involves hormonal imbalances that can complicate management during acute infections.

Observation:

  • A 67-year-old male with CD developed adrenal insufficiency during COVID-19 pneumonia.
  • Management required dose adjustments of CD medications (pasireotide, metyrapone) and hydrocortisone therapy.
  • Potential drug interactions and complications like hyperkalemia were noted.

Findings:

  • COVID-19 infection can precipitate or exacerbate adrenal insufficiency in CD patients.
  • Medical therapies for Cushing's syndrome may need titration or temporary cessation during COVID-19.
  • Hyperkalemia in patients on heparin warrants consideration of aldosterone suppression.

Implications:

  • Prompt recognition and management of adrenal insufficiency are vital in CD patients with COVID-19.
  • Careful consideration of medication interactions between CD treatments and COVID-19 therapies is essential.
  • Clinical vigilance for complications such as hyperkalemia can indicate underlying hormonal shifts.

Keywords:
Cushing's diseaseSARS-Cov-2hypercortisolismpituitaryrare diseases

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