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).