Publication date: Feb 07, 2025

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. Evaluate whether children with AI are more susceptible to the infection or are at risk of severe COVID-19. 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. Multicenter, retrospective. 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. 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.

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