PMC:7108679 / 1379-3253 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7108679","sourcedb":"PMC","sourceid":"7108679","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7108679","text":"More impactful will be the extension of these guidelines to the ~5% of patients in our populations taking chronic therapeutic corticosteroids by differing routes for underlying inflammatory conditions. The prevalence of adrenal insufficiency in these patients is high (~50%) irrespective of mode of delivery (2). Currently there is little evidence to guide us on when to intervene in terms of duration of prior corticosteroid exposure or on the impact of dose, either at a higher dose where supplemental steroid cover may not be necessary or a lower dose where adrenal suppression may not be as prevalent. In the interim, it seems logical, if not essential, that we identify all patients taking corticosteroids for whatever reason as high risk. We know from the published reports to date that these patients will be overrepresented in those at greatest risk of dying from COVID-19—the elderly and those with co-morbidities that include diabetes, hypertension, and chronic inflammatory disease (3,4). Moreover, those patients taking supraphysiologic doses of glucocorticoids may have increased susceptibility to COVID-19 as a result of the immunosuppressive effects of steroids, comorbidities of underlying immune disorders for which the steroids were prescribed, or immunomodulatory actions of other therapies prescribed in conjunction with glucocorticoids for the underlying disease. Reversing potential adrenal failure as a cause of mortality with parenteral glucocorticoid therapy is easy and simple to do once the issue has been recognized. The intent here is to ensure that no patient with a history of prior exposure to chronic glucocorticoid therapy (\u003e3 months) by whatever route should die without consideration for parenteral glucocorticoid therapy. As a community, we will be key to ensuring recognition, management, and implementation of these important measures.","tracks":[]}