Outcomes of COVID-19 in Pediatric Patients with Adrenal Insufficiency
Overview
In a multicenter retrospective study of 1143 children with adrenal insufficiency (AI), 148 contracted COVID-19 and were compared to 74 controls. The prevalence and severity of COVID-19 in children with AI were not increased compared to controls, with similar rates of hospitalization and no COVID-related deaths reported.
Background
COVID-19 generally causes mild illness in children, but some with underlying conditions may experience severe disease. Adrenal insufficiency (AI), characterized by insufficient cortisol production, can increase vulnerability to infections and risk of adrenal crisis. Concerns have been raised about whether children with AI have higher susceptibility or severity of COVID-19, but pediatric data remain limited. This study aimed to evaluate COVID-19 outcomes in children with primary and secondary AI compared to controls.
Data Highlights
Outcome
AI Patients (n=148)
Controls (n=74)
COVID-19 Prevalence
12.9%
Not increased vs general pediatric population
Asymptomatic
14.9%
10.8%
Paucisymptomatic
33.8%
37.8%
Mild
45.3%
45.9%
Severe
3.4%
2.7%
Critical
2.7%
2.7%
Pneumonia
2.7%
4%
MIS-C
2%
2.7%
Adrenal Crisis during Severe COVID-19
3.4%
Not applicable
Hospitalization Rate
9.5%
9.5%
COVID-19 Related Deaths
0%
0%
Key Findings
The prevalence of COVID-19 in children with AI (12.9%) was not higher than in the general pediatric population.
Severity distribution of COVID-19 (asymptomatic to critical) was similar between AI patients and controls.
Rates of pneumonia and multisystem inflammatory syndrome (MIS-C) did not differ significantly between AI patients and controls.
Only 3.4% of AI patients experienced an adrenal crisis during severe COVID-19 episodes.
Hospitalization rates were identical (9.5%) in AI patients and controls.
No COVID-19 related deaths occurred in either group, and all patients fully recovered.
Clinical Implications
Children with adrenal insufficiency do not appear to have increased susceptibility to SARS-CoV-2 infection or a higher risk of severe COVID-19 compared to peers without AI. Standard COVID-19 management protocols remain appropriate for this population, with attention to adrenal crisis prevention during severe illness. These findings support continued routine care and monitoring without additional COVID-19 related restrictions solely based on AI status.
Conclusion
This large multicenter study demonstrates that pediatric adrenal insufficiency is not associated with increased COVID-19 prevalence or severity. Children with AI generally recover well from SARS-CoV-2 infection without excess complications.
References
Author/Source/Year -- Outcomes of COVID-19 in Pediatric Patients with Adrenal Insufficiency: Insights from National Data
by Donatella Capalbo, Cristina Moracas, Laura Guazzarotti, Federico Baronio, Marianna Rita Stancampiano, Rita Ortolano, Mariella Valenzise, Carla Bizzarri, Giuseppa Patti, Silvia Longhi, Claudia Giavoli, Chiara Guzzetti, Silvia Zoletto, Crescenza Lattanzio, Paolo Cavarzere, Maria Elisabeth Street, Maria Felicia Faienza, Anna Grandone, Marco Cappa, Malgorzata Gabriela Wasniewska, Gianni Russo, Mohamad Maghnie, Mariacarolina Salerno, On behalf of the Study Group for Adrenal Diseases of the Italian Society for Pediatric Endocrinology and Diabetes
