Guidance for Endocrinologists During COVID-19 Pandemic- The
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In response to the COVID-19 pandemic, endocrinologists should take certain precautions with patients they commonly treat, according to new guidance from editors of The Journal of Clinical Endocrinology & Metabolism.

Patients on Corticosteroids:

For patients with primary and secondary adrenal insufficiency taking glucocorticoid-replacement therapy, "sick day rules" should be enforced, Stewart and co-editors advised. Any patient with a dry continuous cough and fever should immediately double their daily oral glucocorticoid dose and continue on this regimen until the fever has subsided, and deteriorating patients and those with vomiting or diarrhea should seek urgent medical care and be treated with parenteral glucocorticoids.

The same guidance should apply to patients taking chronic therapeutic corticosteroids by whatever route for underlying inflammatory conditions, noting that approximately half of such patients have adrenal insufficiency. "In the interim, it seems logical, if not essential, that we identify all patients taking corticosteroids for whatever reason as high risk."

Patients with Pituitary or other Neuroendocrine Disease:

Similar to the situation for patients with primary adrenal insufficiency, many patients with pituitary or other neuroendocrine diseases have hypopituitarism including secondary adrenal insufficiency. If presenting with a dry continuous cough and fever, these patients should be given stress dose glucocorticoid supplementation as well. It is also important to remember that these patients may have diabetes insipidus, which further compounds fluid and electrolyte disorders and requires careful monitoring as well as water and electrolyte replacement to prevent hyponatremia or hypernatremia. "This is particularly important in the context of increased insensible fluid loss associated with fever and tachypnea, combined with impaired ability for fluid intake with altered level of consciousness," the editorial stated.

Patients with Diabetes

For patients with diabetes, the risk of contracting a viral illness is not greater, but the severity of the disease can be much worse, the editorialists said. Recent studies from the Wuhan province in China reported that patients with diabetes were overrepresented among the most severely ill with COVID-19 and those who died from the disease.

Current guidance from the Centers for Disease Control and Prevention for prevention of COVID-19 for those with diabetes is no different than the general population, but the recognition that diabetes poses a greater risk for severity of illness should prompt health-care providers to be more vigilant in the assessment of such patients who present with concerning symptoms (i.e., shortness of breath, fever).

This list is a brief compilation of some of the key recommendations included in the Guideline and is not exhaustive and does not constitute medical advice.

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