Discussion
My case suggests that SARS-CoV-2 in a child may demonstrate a fairly stable clinical course even in the presence of underlying adrenal insufficiency. In a longitudinal assessment of 156 patients with CAH, gastrointestinal and upper respiratory illnesses were the predominant reasons for stress dosing, adrenal crises, and hospital admissions (4).
Patients with adrenal insufficiency are at risk to develop a potentially life-threatening adrenal crisis if experiencing major stress, such as an acute illness. This requires administration of increased doses of glucocorticoid replacement to prevent and, if already in progress, treat the adrenal crisis (5, 6). Adrenal crises are regularly observed in patients with PAI and SAI (7, 8) and contribute to the observed increased mortality in these patients.
There are limited cases diagnosed by COVID-19 and CAH. It can because of good compliance of patients and their parents, awareness of their families about stress dose of corticosteroids during illness phase and maybe their more cautions in performing prevention strategies. Subjects with immunocompromised status or with certain chronic diseases are included in the list of diseases requiring additional precautionary measures to reduce risk of COVID-19 and those patients with CAH known to have an element of immune deficiency because of defective action of neutrophils and natural killer cells , as well as having cortisol deficiency and on lifelong treatment, because of this factors, the risk of infection in that patient higher than the normal population by two to eight-fold (9).
Patients with adrenal insufficiency are at higher risk to develop a potentially life-threatening adrenal crisis if experiencing major stress, such as an acute illness. This requires administration of increased doses of glucocorticoid replacement to prevent and, if already in progress, treat the adrenal crisis (10). Adrenal crises are regularly observed in patients with PAI and SAI (11) and contribute to the observed increased mortality in these patients. It was also noted that stress dosing was more common in children compared to adults which could potentially be attributed to the fact that parents tend to be more vigilant about their children’s presentation and need for management compared to adults treating themselves (4).