Children with Adrenal Insufficiency at 10 Times Greater Mortality Risk from COVID-19

New research presented at ENDO 2021 is sounding the alarm on a dramatic increase in mortality risk from COVID-19 among children with adrenal insufficiency.

An analysis that included data from nearly 900 children with adrenal insufficiency and COVID-19 indicates the risk of dying from COVID-19 was more than 10 times greater among these children compared to children without adrenal insufficiency.

"Adrenal insufficiency may put a person at higher risk of infections due to a lack of normal stress response by the body," said lead researcher Manish Rasingani, MD, of the University of Arkansas for Medical Sciences and Arkansas Children’s, in a statement. "Until now, there has been limited data on children with adrenal insufficiency and COVID-19."

With most instances in children linked to Addison’s disease, adrenal insufficiency in children is characterized by inadequate production of cortisol and aldosterone. Due to insufficient levels of cortisol in these patients, they are often at an increased risk of infections.

With adrenal insufficiency placing patients at increased risk of infections, investigators designed the current study to further understand how presence of this condition could influence mortality risk in pediatric populations. Using TriNetX and a large COVID-19 database, investigators obtained information related to more than 250,000 children 0-18 years of age from 54 health care organizations.

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From their search, investigators identified 252,211 patients with COVID-19 without adrenal insufficiency and 846 patients with COVID-19 and adrenal insufficiency. Overall, the mortality rate among children with COVID-19 and adrenal insufficiency was 2.246% (19/846) compared to 0.097% (244/252,211)—this equates to a relative risk of 23.2 (P <.0001).

When assessing treatment of COVID-19 in these patients groups, results indicated children with adrenal insufficiency experienced endotracheal intubation at a greater rate (1.418%; n=12/846) than their counterparts without adrenal insufficiency (0.065%; n=165/252,211). Investigators noted the relative risk of endotracheal intubation for children with COVID-19 and adrenal insufficiency was 21.68 (P<.0001).

When examining sepsis in these groups, results indicated an increased rate of sepsis among children with COVID-19 and adrenal insufficiency (6.974%; n=59/846) compared to those with COVID-19 without adrenal insufficiency (0.274%; n=691/252,211). Overall, the relative risk among children with COVID-19 and adrenal insufficiency was 25.45 (P <.00001).

"This study shows it is important to take extra precautions to prevent and treat COVID-19 infection in children with adrenal insufficiency," Raisingani said.

This study, “Risk of Complications in Children With Adrenal Insufficiency and COVID-19,” was presented at ENDO 2021.