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April 3, 2020 Endocrinologists have underscored the importance of physicians considering a "stress dose" of glucocorticoids for severe COVID-19 infection in endocrine and other long-term steroid patients.People who routinely take corticosteroids for a variety of underlying inflammatory conditions, such as asthma, allergies, and arthritis, are at high risk of becoming infected with COVID-19 and being negatively affected.This also applies to a rarer group of patients with adrenal insufficiency and uncontrolled Cushing's syndrome, as well as the secondary adrenal insufficiency that occurs in hypopituitarism, who also depend on glucocorticoids for everyday life.

In the case of COVID-19, all these individuals may be unable to generate a normal response to stress and "in the case of adrenal suppression such patients may have serious difficulties, particularly if they are in intensive care units", warns Paul Stewart, MD, University of Leeds, UK, and editor-in-chief of the Journal of Clinical Endocrinology & Metabolism (JCEM).As such, it is vitally important to recognize that "injectable supplemental glucocorticoid therapy in this setting can reverse the risk of life-threatening adrenal insufficiency and should be considered in all cases," Stewart and colleagues emphasize in a recently published editorial in JCEM.They point out that this advice should be considered together with the guidance of the World Health Organization (WHO) against the prescription of therapeutic glucocorticoids to treat complications of COVID-19, based on previous experience in patients with acute respiratory distress syndrome, as well as those affected by severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).The key difference here is not using pharmacological doses of glucocorticoids as treatment for COVID-19 (where they have no effect), but rather preventing death from adrenal insufficiency by using replacement glucocorticoid stress doses, Stewart explained to Medscape Medical News."The intention here is to ensure that no patient with a history of prior exposure to chronic glucocorticoid therapy (> 3 months) by any route dies without taking parenteral glucocorticoid therapy into account," the editorialists write.He advises using physiological stress doses of hydrocortisone (50-100 mg intravenously).. (tagsToTranslate) steroids (t) Coronavirus (t) 2019 New coronavirus (t) 2019-nCoV (t) Wuhan coronavirus (t) Human coronavirus HKU1 (t) Human coronavirus OC43 (t) HCoV-OC43 (t) Human coronavirus 229E ( t) HCoV-229E (t) glucocorticosteroids (t) adrenal insufficiency (t) adrenal disease (t) crush

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Patients taking steroids with COVID-19 may need rescue steroids. - NewsDio

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