Clinical course of COVID-19 in children with adrenal insufficiency: results from national data

Context: There has been concern about a potential increase in the incidence or severity of coronavirus disease 2019 (COVID-19) in individuals with adrenal insufficiency (AI). Data on the course of SARS-CoV-2 infection in AI children are lacking. Objective: Evaluate whether children with AI are more susceptible to the infection or are at risk of severe COVID-19. Methods: In this multicenter, retrospective study among 1143 children with AI, 148 contracted SARS-CoV-2 (112 with primary, 36 with secondary AI) and were evaluated for severity and outcomes of infection, along with 74 control subjects with normal adrenal function. Results: The prevalence of COVID-19 in the AI cohort was 12.9%, not increased compared to pediatric Italian population in the same period. The severity was not increased in AI subjects and was classified as follows in patients vs controls: asymptomatic in 14.9% vs 10.8%; paucisymptomatic in 33.8% vs 37.8%; mild in 45.3% vs 45.9%; severe in 3.4% vs 2.7%; critical in 2.7% vs 2.7%. Among those with severe COVID, 4 patients with AI (2.7%) and 3 controls (4%) developed pneumonia while 3 patients with PAI (2%) and 2 controls (2.7%) developed multisystem inflammatory syndrome (P not statistically significant). Only 5 patients (3.4%) experienced an adrenal crisis during a severe COVID-19. The hospitalization rate was the same in patients vs controls (9.5%). All subjects completely recovered, and no COVID-related deaths were documented. Conclusion: Our findings do not indicate that AI is associated with increased susceptibility to SARS-CoV-2 infection or higher risk for severe COVID-19 in children.