Departments of Medicine and Neurosurgery, Stanford University, 875 Blake Wilbur Dr., MC 5821, Stanford, CA, 94305-5821, USA.
Neuroendocrinology Research Center/Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Pituitary. 2021 Apr;24(2):143-145. doi: 10.1007/s11102-021-01130-x. Epub 2021 Feb 10.
Side effects of the coronavirus disease 2019 (COVID-19) vaccines include pain at the injection site, fatigue, headache, myalgias, arthralgias, chills, and fever, all of which can be early indicators of an increased need for glucocorticoid replacement in patients with adrenal insufficiency. The Pituitary Society surveyed its membership to understand planned approaches to glucocorticoid management in patients with adrenal insufficiency who will receive a COVID-19 vaccine.
Members were asked to complete up to 3 questions regarding their planned approach for use of glucocorticoid replacement in patients with proven adrenal insufficiency.
Surveys were sent to 273 members and 103 responded. Thirty-six percent plan to recommend that patients automatically increase glucocorticoid dosage with administration of the first vaccine injection. Of these, 84% plan to increase glucocorticoid dose on the day of vaccination, and 49% plan to increase glucocorticoid dose prior to vaccination. Of the 64% who do not plan to recommend automatic glucocorticoid dose increase with vaccine administration, 88% plan to increase the dose if the patient develops a fever, and 47% plan to increase the dose if myalgias and arthralgias occur.
Most clinicians plan to maintain the current glucocorticoid dose with vaccine administration. The vast majority plan and to increase glucocorticoid dose in case of fever, and just under half in case of arthralgias and myalgias. These survey results offer suggested management guidance for glucocorticoid management in patients with adrenal insufficiency.
新冠病毒疾病 2019（COVID-19）疫苗的副作用包括注射部位疼痛、疲劳、头痛、肌痛、关节痛、寒战和发热，所有这些都可能是肾上腺功能不全患者需要增加糖皮质激素替代治疗的早期指标。垂体学会对其成员进行了调查，以了解计划在接受 COVID-19 疫苗的肾上腺功能不全患者中管理糖皮质激素的方法。
要求成员就其计划在已确诊的肾上腺功能不全患者中使用糖皮质激素替代治疗的方法回答最多 3 个问题。
向 273 名成员发送了调查，有 103 名成员做出了回应。36%的人计划建议患者在第一次接种疫苗时自动增加糖皮质激素剂量。其中，84%计划在接种日增加糖皮质激素剂量，49%计划在接种前增加糖皮质激素剂量。在不计划建议患者在接种疫苗时自动增加糖皮质激素剂量的 64%中，88%计划在患者出现发热时增加剂量，47%计划在出现肌痛和关节痛时增加剂量。
大多数临床医生计划在接种疫苗时维持当前的糖皮质激素剂量。绝大多数计划在出现发热时增加糖皮质激素剂量，接近一半的人在出现肌痛和关节痛时增加剂量。这些调查结果为肾上腺功能不全患者的糖皮质激素管理提供了建议的管理指导。
