Table 2.

Management of Patients with Preexisting Endocrine Conditions who are Affected with COVID-19

Endocrine Condition	Management
Diabetes insipidus	Titrate the dose of desmopressin according to serum sodium, and osmolality. Convert to parenteral form (IV/IM) if intranasal route is not feasible [52] Desmopressin dose equivalents [138]
	Tablets	Spray	Injections
	100 µg	2.5 µg	NA
	200 µg	5.0 µg	<0.5 µg
	400 µg	10.0 µg	<1.0 µg
Hyperprolactinemia	Bromocriptine: may need dose adjustment because of interactions between lopinavir/ritonavir, which increase bromocriptine levels [55] Cabergoline: dose adjustment is not required
GH deficiency	Continue on the same dose of growth hormone in those with established GH deficiency [58]
Hypoadrenalism	Double the morning dose of hydrocortisone and continue 20 mg 4 times daily, or give doubled usual hydrocortisone dose (“sick day rule”), depending on the infection severity and patient characteristics [64] During an adrenal crisis, IM or IV hydrocortisone 100 mg stat followed by 200 mg over 24-hour infusion [66] Patients with primary hypoadrenalism do not require increasing fludrocortisone dose [65] Critical illness-related corticosteroid insufficiency (CIRCI): IV hydrocortisone 400 mg daily for 3 days or longer depending on the requirement [70]
Cushing’s syndrome	Continue medical management in those with active disease IV etomidate at a rate of 0.04 to 0.05 mg/kg/h for those with severe illness targeting a cortisol level 500-800 nmol/L [78, 79] Anticoagulation to be considered in acute illness [75]
Pheochromocytoma/paraganglioma	Treatment with initial alpha-adrenoceptor blockers followed by beta-adrenoceptor blockers depending on the blood pressure and heart rate [81]
Hypothyroidism	No thyroxine dose adjustments are required
Hyperthyroidism	Dose adjustment of antithyroid medications as usual according to the thyroid function tests. If blood tests cannot be performed, dose adjustments may be made based on thorough history and examination. Short-term block and replacement therapy as an alternative [87]
Hypoparathyroidism	Ensure a continuous supply of calcium supplements Maintain normocalcemia as hypocalcemia increases the risk of QT prolongation with chloroquine/hydroxychloroquine and azithromycin [112]
Vitamin D deficiency	Vitamin D supplements to achieve a target level of > 50 nmol/L (20 ng/mL) [130] During winter seasons, 2000-5000 IU daily up to 10 000 IU depending on the requirement [131, 132]
Hypogonadism	Testosterone Temporary discontinuation may be possible if medication is not available or changing to an alternative is possible (e.g., intramuscular injections to testosterone gel) Estrogen Conversion to transdermal formulations when applicable as the thrombosis risk is lower with transdermal compared to oral estrogen