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. Patients: 1143 children with AI. Of these, 148 patients, 112 with primary (PAI) and 36 with secondary AI (SAI), and 74 control subjects with normal adrenal function, who contracted SARS-CoV-2, were evaluated for the severity and outcomes of infection. Design: Multicenter, retrospective. Results: The prevalence of COVID-19 in 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 MIS-C (p=ns). Only 5 patients (3.4%) experienced an adrenal crisis during a severe COVID-19. Hospitalization rate was the same in patients vs controls (9.5%). All subjects completely recovered and no COVID-related deaths were documented. Conclusions: 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.