ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency.
ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of adrenal insufficiency.
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DOI：
10.1530/eje-20-0361
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发表时间：
2020-07
影响因子：
5.8
通讯作者：
Simpson HL
中科院分区：
文献类型：
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作者：
Arlt W;Baldeweg SE;Pearce SHS;Simpson HL
我们提供了在全球 COVID-19 危机期间预防肾上腺危机的指南，在这段时期内，获得通常水平的医疗保健的机会经常受到限制。肾上腺功能不全患者感染的风险增加，肾上腺危象可能使情况变得复杂；然而，目前没有证据表明肾上腺功能不全患者更有可能出现严重的病程。我们强调需要教育（病假规则、严格的社交距离规则）、设备（充足的糖皮质激素供应、类固醇紧急自我注射套件）和赋权（类固醇紧急卡、COVID-19 指南）来预防肾上腺危机。对于发生急性 COVID-19 感染（经常表现为持续高烧）的肾上腺功能不全患者，我们建议每 6 小时口服 20 毫克氢化可的松。我们还评论了通常服用改良释放氢化可的松或泼尼松龙的患者的建议剂量。对于在急性 COVID-19 感染期间表现出临床恶化的肾上腺功能不全患者，我们建议立即（自行）肌肉注射 100 毫克氢化可的松，然后持续静脉注射。每 24 小时输注 200 mg 氢化可的松，或直至确定为止，每 6 小时输注 50 mg 氢化可的松。我们还就婴儿和儿童的剂量提供建议。
We provide guidance on prevention of adrenal crisis during the global COVID-19 crisis, a time with frequently restricted access to the usual level of healthcare. Patients with adrenal insufficiency are at an increased risk of infection, which may be complicated by developing an adrenal crisis; however, there is currently no evidence that adrenal insufficiency patients are more likely to develop a severe course of disease. We highlight the need for education (sick day rules, stringent social distancing rules), equipment (sufficient glucocorticoid supplies, steroid emergency self-injection kit) and empowerment (steroid emergency card, COVID-19 guidelines) to prevent adrenal crises. In patients with adrenal insufficiency developing an acute COVID-19 infection, which frequently presents with continuous high fever, we suggest oral stress dose cover with 20 mg hydrocortisone every 6 h. We also comment on suggested dosing for patients who usually take modified release hydrocortisone or prednisolone. In patients with adrenal insufficiency showing clinical deterioration during an acute COVID-19 infection, we advise immediate (self-)injection of 100 mg hydrocortisone intramuscularly, followed by continuous i.v. infusion of 200 mg hydrocortisone per 24 h, or until this can be established, and administration of 50 mg hydrocortisone every 6 h. We also advise on doses for infants and children.