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Published on: September 15, 2017
Clinical Course of COVID-19 in Children With Adrenal Insufficiency: Results From National Data
Donatella Capalbo1, Cristina Moracas2, Laura Guazzarotti3
1Unit of Pediatric Endocrinology, Department of Medical and Translational Sciences, University of Naples Federico II, 80131 Naples, Italy.
Insights
Children with adrenal insufficiency (AI) do not face increased risk for COVID-19 infection or severe outcomes. This study found no significant difference in susceptibility or disease severity compared to healthy children.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Public Health
Background:
- Concerns exist regarding increased COVID-19 incidence and severity in children with adrenal insufficiency (AI).
- Limited data are available on SARS-CoV-2 infection outcomes specifically in pediatric AI populations.
Purpose of the Study:
- To determine if children with AI are more susceptible to SARS-CoV-2 infection.
- To assess if children with AI face a higher risk of severe Coronavirus Disease 2019 (COVID-19).
Main Methods:
- A multicenter, retrospective study evaluated 148 children with AI (112 primary, 36 secondary) and 74 controls with normal adrenal function who contracted SARS-CoV-2.
- Infection severity, outcomes, and complications such as pneumonia and MIS-C were analyzed.
Main Results:
- The prevalence of COVID-19 in the AI cohort (12.9%) was comparable to the general pediatric population.
- No increased severity was observed in AI subjects; hospitalization rates and outcomes (pneumonia, MIS-C) were similar to controls.
- Only 3.4% of AI patients experienced adrenal crisis during severe COVID-19; all subjects recovered fully with no COVID-19-related deaths.
Conclusions:
- Adrenal insufficiency (AI) in children is not associated with increased susceptibility to SARS-CoV-2 infection.
- Children with AI do not exhibit a higher risk for severe Coronavirus Disease 2019 (COVID-19) or adverse outcomes.
Context:
There has been concern about a potential increase in the incidence or severity of coronavirus disease 2019 (COVID-19) in individuals with adrenal insufficiency (AI). Data on the course of SARS-CoV-2 infection in AI children are lacking.
Objective:
Evaluate whether children with AI are more susceptible to the infection or are at risk of severe COVID-19.
Methods:
In this multicenter, retrospective study among 1143 children with AI, 148 contracted SARS-CoV-2 (112 with primary, 36 with secondary AI) and were evaluated for severity and outcomes of infection, along with 74 control subjects with normal adrenal function.
Results:
The prevalence of COVID-19 in the AI cohort was 12.9%, not increased compared to pediatric Italian population in the same period. The severity was not increased in AI subjects and was classified as follows in patients vs controls: asymptomatic in 14.9% vs 10.8%; paucisymptomatic in 33.8% vs 37.8%; mild in 45.3% vs 45.9%; severe in 3.4% vs 2.7%; critical in 2.7% vs 2.7%. Among those with severe COVID, 4 patients with AI (2.7%) and 3 controls (4%) developed pneumonia while 3 patients with PAI (2%) and 2 controls (2.7%) developed multisystem inflammatory syndrome (P not statistically significant). Only 5 patients (3.4%) experienced an adrenal crisis during a severe COVID-19. The hospitalization rate was the same in patients vs controls (9.5%). All subjects completely recovered, and no COVID-related deaths were documented.
Conclusion:
Our findings do not indicate that AI is associated with increased susceptibility to SARS-CoV-2 infection or higher risk for severe COVID-19 in children.
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