key: cord-1017121-ueeu3yip
authors: Serban, A. L.; Ferrante, E.; Carosi, G.; Indirli, R.; Arosio, M.; Mantovani, G.
title: COVID-19 in Cushing disease: experience of a single tertiary centre in Lombardy
date: 2020-09-11
journal: J Endocrinol Invest
DOI: 10.1007/s40618-020-01419-x
sha: aafa1700aabbc7cf291477f77978e619e636d27a
doc_id: 1017121
cord_uid: ueeu3yip

nan

group included all the patients with confirmed CD that underwent at least one endocrinological evaluation during the last 12 months at our centre. We performed a telephone inquire that included information related to influenza vaccination, risky behaviours for COVID-19 (smoking, work, travel, cohabitants number), suggestive clinical features (fever, cough, dyspnoea, anosmia, ageusia, conjunctivitis, diarrhoea, tiredness) and COVID-19 testing, from January to mid-April 2020. All the contacted patients responded to the telephone call.

The CD group included 15 cases of active hypercortisolism, 28 patients in remission with hypoadrenalism and 18 eucortisolemic subjects. The two groups had the same mean age and gender distribution (CD 52.6 ± 12.4, controls 52.7 ± 11.7 years, female percent 83.3% in both groups). The presence of risky behaviours and influenza vaccination rate were similar in the two groups (Table 1) .

We found two cases (3.2%) of virologically confirmed COVID-19 in CD patients, but none in the control group. The first patient was a 55-year old woman in remission, with hypoadrenalism adequately treated, end-stage chronic kidney disease, and malnutrition. She was admitted in the Pulmonary Unit and treated with hydroxychloroquine, Continuous Positive Airway Pressure and hydrocortisone continuous infusion 200 mg/24 h. Unfortunately, she died after 6 days of hospitalisation. The second, a 71-year old man with active hypercortisolism, obesity, hypertension, dyslipidaemia who discontinued metyrapone one month before because of gastrointestinal disturbances; his general state improved after one week of isolation in a non-medical structure.

Because of the small number of patients tested by nasopharyngeal swab for COVID-19 both in Lombardy (221.968/10.000.000) [1] and in our population (5/122), we also investigated the presence of characteristic signs and symptoms. Overall, almost 38% of CD and 47% of controls had at least one clinical feature between January and mid-April. Considering a more specific clinical presentation as the association of fever and dry cough with other symptoms, lasting for at least one week between March and mid-April (when influenza was unlikely), we found four CD patients and one subject with pituitary microincidentaloma. Three of four CD patients had active hypercortisolism: one patient had persistent CD after pituitary surgery and two were newly diagnosed CD patients waiting for surgical treatment.

Our survey was conducted on a relatively small cohort of CD patients with only 15 cases of active hypercortisolism that precludes statistical conclusions. Furthermore, remote assessment did not permit an objective clinical examination and therefore under-as well as over-estimation of some symptoms cannot be excluded. Nevertheless, it shows that 3.2% of CD had confirmed COVID-19 compared with 0.6% of the general population in Lombardy by mid-April [1].

Moreover, a severe clinical presentation was observed especially in patients with active CD, suggesting that chronic hypercortisolism may be associated with more serious SARS-CoV-2 infection. Overall, our data indicate that active CD patients should be considered as a fragile population.

Conflict of interest On behalf of all authors, the corresponding author states that there is no conflict of interest.

The study was approved by Milan Area 2 Ethical Committee (ID 1623). The study was performed in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent Informed consent was obtained from all individual participants included in the study. 

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