ODP349 Risk of Coronavirus Disease 2019 (COVID-19) in patients with Cushing's Disease (CD) is increased and independently associated with both obesity and disease activity
Authors: Mascarenhas Nakano Bruna M , Fracacio Silvia M , Brock Paola W , Dias Rossella F , Binda Eduarda S , Miglioli Adriana G , Santos-Neto Pedro F , Portari Luiz H , Sanudo Adriana , Abucham Julio 
Published: November 2022

Abstract
Patients with Cushing's disease (CD) are usually immunosuppressed due to chronic hypercortisolism, therefore more susceptible to COVID-19. Comorbidities like obesity, hypertension and diabetes mellitus (DM), highly prevalent in CD, have been shown to increase severity of COVID-19 in the general population. The aim of this study was to evaluate the incidence, risk factors, and outcome of COVID-19 in a cohort of CD patients from February/15 2020 to November/15 2021 (before the arrival of the Omicron variant in Brazil). Sixty out of 66 CD patients were included (54F). From October/1 to November/30/2021, patients or family members answered a questionnaire about the diagnosis and time of COVID-19 infection (PCR-confirmed), its outcome and vaccination status through phone interview. Clinical and biochemical data, obtained from our electronic medical records, showed that 15 patients were in hypercortisolism (25%) and 45 were in remission (75%). A similar proportion was found among those 6 patients that did not participate in the study. The cumulative incidence of COVID-19 in the cohort during the entire observation period (22 months) was 32% (19/60), much higher than reported in the general reference population within the same area during the same period (9.5%). Since vaccination only started in February/2021, 55 patients were considered as not fully vaccinated (less than two doses) up to July/2021 (observation period: 17 months). In those patients, the cumulative incidence of COVID-19 during that period of time was also higher (27%) than in the reference population (8.4%). When CD patients were stratified according to comorbidities, the cumulative incidence of COVID-19 was shown to be significantly higher in patients with active disease (hypercortisolism) [57%vs 17%,P= 0. 012] and in those with obesity [54%vs 9%,P&lt;0. 001], but not with hypertension or DM. In multivariate analysis, both hypercortisolism and obesity were independent risk factors for COVID-19 in CD patients [RR=2.1 (CI: 1-4.4),P=0. 05 andRR=4.8 (CI: 1.5-15.5),P=0. 009, respectively]. One single patient (5.2%) died from COVID-19 (she had hypercortisolism, obesity, hypertension and DM). During the next 5 months, when all 60 patients had been fully vaccinated, there were four (4/41) new infections and no (0/19) reinfection. The incidence of COVID-19 is higher in CD patients and is associated with hypercortisolism, as expected, and more strongly with obesity, which is a novel and unexpected finding that has only recently been reported in the general population (1). Thus, correction of hypercortisolism, obesity, and preventive measures should be more aggressively implemented in CD patients during the current COVID-19 pandemia. Reference: (1) Recalde et al., J Clin Endocrinol Metab. 2021 Nov 19;106(2): e5030-e5042.
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