Practical Considerations for the Management of Cushing's Disease and COVID-19: A Case Report
Federica Beretta, Francesca Dassie, Matteo Parolin, Federico Boscari, Mattia Barbot, Luca Busetto, Roberto Mioni, Eugenio De Carlo, Carla Scaroni, Francesco Fallo, Roberto Vettor, Pietro Maffei
Abstract
Introduction. Italy, since the end of February 2020, is experiencing the COVID-19 pandemic, that may present as an acute respiratory infection. We report on COVID-19 pneumonia in the context of a complex case of Cushing’s disease (CD). Case report. A 67-years-old man with CD, admitted to our hospital, presented with signs and symptoms of adrenal insufficiency with persistent hypotension and glycemia towards the lower limits. We progressively withdrawed almost all treatments for diabetes and CD (pasireotide and metyrapone) and i.v. hydrocortisone was necessary. A tendency to hyperkalemia was probably associated to enoxaparina. We summarized the many possible interactions between medications of Cushing’s syndrome (CS) and COVID-19. Conclusion. Adrenal insufficiency might be a clinical challenge that need a prompt treatment also in CS patients during COVID-19 infection. We should consider the possibility to titrate or temporary halt medical therapies of CS in the context of COVID-19 infection. Unexpected hyperkalemia in CS patients under treatment with heparin might be the signal of aldosterone suppression.