In 2017, new research was published regarding mortality and primary adrenal insufficiency (Addison’s disease). In 2020 at the start of the COVID outbreak, the research went viral in our community, as people were searching for information, trying to learn how the COVID virus may impact them, and if this research may apply to the pandemic.

The research titled: “Primary adrenal insufficiency is associated with impaired natural killer cell function: a potential link to increased mortality”, involved a 'cross-sectional study of 42 patients with PAI due to autoimmune adrenalitis or bilateral adrenalectomy and 58 sex- and age-matched controls'.

Professor Wiebke Arlt, one of the researchers behind the research, kindly provides her perspective on what this research means for those with primary adrenal insufficiency in the current climate. We've collated her thoughts on this below for those without a Twitter account.

 

Every patient with Addison should continue to take their steroid replacement, not taking it, means risking life-threatening adrenal crisis! Patients with Addison have been shown by our group and an Italian group to have a reduced response of Natural killer cells fighting viruses.

— Wiebke Arlt (@WiebkeArlt) March 16, 2020

This might mean that patients with Addison's disease might be catching infections more easily than healthy people and in a recent paper we published we have shown that both patients with Addison's disease and congenital adrenal hyperplasia have an increased rate of infections

— Wiebke Arlt (@WiebkeArlt) March 16, 2020

However, the degree of immune-suppression we observed is much smaller than in patients who take very high doses of glucocorticoids to suppress chronic inflammatory disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohn's

— Wiebke Arlt (@WiebkeArlt) March 16, 2020

Therefore, patients with Addison's disease should be at least as cautious as other people in following the government recommended social distancing measures, but they are at a much lower risk of infections than patients receiving high dose steroids or cancer treatment

— Wiebke Arlt (@WiebkeArlt) March 16, 2020

We are grateful to Professor Arlt for responding with her view on the research and its implications.

If you feel concerned or are looking for more information, please visit our Sanctuary of Support page. There you can choose the section that suits the way you are feeling today and find out the support we have on offer for you.

	Professor Wiebke Arlt MD DSc FRCP FMedSci Twitter: @WiebkeArlt
	Read: Irina Bancos, Jon Hazeldine, Vasileios Chortis, Peter Hampson, Angela E Taylor, Janet M Lord, Wiebke Arlt, Primary adrenal insufficiency is associated with impaired natural killer cell function: a potential link to increased mortality, European Journal of Endocrinology, Volume 180, Issue 6, Jun 2019, Page X5, https://doi.org/10.1530/EJE-16-0969e
	Visit our vaccines page to learn more about the flu vaccine, COVID booster and more.
	Learn more about the Sick Day Rules. People with Addison's and adrenal insufficiency are particularly vulnerable to adrenal crisis being triggered by seemingly "minor" ailments, including vomiting, diarrhoea, colds and flu. It's important to recognise the early symptoms of a bug or cold and adjust steroid replacement medication accordingly. These guidelines are known as the Sick Day Rules.

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