Survey of glucocorticoid dose escalation in patients with adrenal insufficiency during the peri-COVID-19 vaccination period

Hironori Bando; Masaaki Yamamoto; Michiko Takahashi; Keitaro Kanie; Yuriko Sasaki; Yuka Oi; Seiji Tomofuji; Kaori Hozumi; Seiji Nishikage; Shin Urai; Naoki Yamamoto; Masaki Suzuki; Hiroki Shichi; Genzo Iguchi; Hidenori Fukuoka; Wataru Ogawa

doi:10.1507/endocrj.EJ22-0390

ORIGINAL

Survey of glucocorticoid dose escalation in patients with adrenal insufficiency during the peri-COVID-19 vaccination period

Hironori Bando, Masaaki Yamamoto, Michiko Takahashi, Keitaro Kanie, Yuriko Sasaki, Yuka Oi, Seiji Tomofuji, Kaori Hozumi, Seiji Nishikage, Shin Urai, Naoki Yamamoto, Masaki Suzuki, Hiroki Shichi, Genzo Iguchi, Hidenori Fukuoka, Wataru Ogawa

Author information

Hironori Bando
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
Masaaki Yamamoto
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
Michiko Takahashi
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
Department of Nutrition, Kobe University Hospital, Kobe, Japan
Keitaro Kanie
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
Yuriko Sasaki
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
Yuka Oi
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
Seiji Tomofuji
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
Kaori Hozumi
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
Seiji Nishikage
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
Shin Urai
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
Naoki Yamamoto
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
Masaki Suzuki
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
Hiroki Shichi
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
Genzo Iguchi
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
Division of Biosignal Pathophysiology, Kobe University Graduate School of Medicine, Kobe, Japan
Medical Center for Student Health, Kobe University, Kobe, Japan
Hidenori Fukuoka
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Japan
Wataru Ogawa
Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

Keywords: COVID-19, Vaccination, Adrenal insufficiency, Steroid cover

JOURNAL FREE ACCESS FULL-TEXT HTML

2023 Volume 70 Issue 1 Pages 89-95

DOI https://doi.org/10.1507/endocrj.EJ22-0390

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Abstract

There is uncertainty regarding the need for COVID-19 peri-vaccination glucocorticoid coverage in patients with adrenal insufficiency. In this survey conducted in a single tertiary medical institution, 167 consecutive outpatients taking physiological glucocorticoids because of adrenal insufficiency were included. The patients declared if they developed an adrenal crisis after vaccination, and the amount and duration of an increase in their glucocorticoid dosage, if any. None of the patients without preventive glucocorticoid increase suffered an adrenal crisis after COVID-19 vaccination. Only 8.3% (14 cases) and 27.5% (46 cases) of the patients needed to escalate the dose of glucocorticoids when systemic symptoms appeared after the first and second injections, respectively. Glucocorticoids were increased in patients <60 years of age more than in patients ≥60 years of age at the time of both the first (p = 0.026) and second injections (p = 0.005). Sex and the causes of adrenal insufficiency were not associated with the frequency of the patients who needed glucocorticoid dose escalation. In the cases with increased glucocorticoids, the median dosage for escalation was 10 mg (hydrocortisone equivalent). In conclusion, even without prophylactic glucocorticoid administration, adrenal crisis did not occur during the peri-COVID-19 vaccination period. The dose escalation of steroid was more frequent in younger patients following the second vaccination. Careful monitoring of adverse effects and the appropriate management of glucocorticoids when necessary are essential following COVID-19 vaccinations.

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