COVID-19 infections in patients with adrenal cortex failure

Primary adrenal failure is a rare disease, most commonly caused by autoimmune destruction of the adrenal cortex, leading to a deficiency of the vital adrenal hormones cortisol and aldosterone. Treatment of the disease is the lifelong administration of cortisol and aldosterone derivatives. In the case of acute disease of primary adrenal failure, the need for cortisol is increased, and if an insufficient amount of cortisol is admitted, a potentially fatal adrenal crisis can occur. Therefore, patients with adrenal failure are generally particularly susceptible to a severe case history of bacterial or viral infections.

The coronavirus SARS-Cov-2 was first detected in humans in late fall 2019, leading to the respiratory infection COVID-19. The way of infection is through drop and contact infection. The virus is highly contagious and has caused a global pandemic in the winter of 2020. The symptoms of COVID-19 range from mild respiratory symptoms to severe disease with viral pneumonia, respiratory failure and death.

Our research hypothesis is that people with primary adrenal failure are more prone to COVID-19, and that they will have a more severe case history than people without risk factors. This project is based on the Register for Organ-Specific Autoimmune Diseases (ROAS), which is a consent-based quality and research registry primarily for patients with adrenal failure and polyendocrine failure. The project will map the clinical course of COVID-19 in adrenal failure, and the incidence of severe progression and death compared with the general population. In the study, immune responses to SARS-COV-2 virus in blood will also be mapped. All patients with known adrenal insufficiency and proven COVID-19 admitted to the country's hospitals will be asked for inclusion by local ROAS physicians, and biobank samples will be taken at registration, 4-6 weeks and 6 months after undergoing infection. In the study, ROAS consent will be used, and patients not included in the ROAS will be asked for ROAS consent. All persons with adrenal failure included in the ROAS will be sent a self-report form (PROMs) for completion in the event of COVID-19 infection. Data on COVID-19 in adrenal failure are not yet available, and the study is expected to be of great benefit.