Endocrinology in the time of COVID-19: Management of Cushing's syndrome

in European Journal of Endocrinology

Correspondence: John Newell-Price, Email: j.newellprice@sheffield.ac.uk

• Clinical evaluation should guide those needing investigation

• Strict adherence to COVID-19 protection measures is necessary

• Alternative ways of consultations (telephone, video) should be used

• Early discussion with regional/national experts about investigation and management of potential and existing patients is strongly encouraged

• Patients with moderate and severe clinical features need urgent investigation and management

• Patients with active Cushing’s syndrome, especially when severe, are immunocompromised and social shielding is recommended

• In patients with mild features or in whom a diagnosis is less likely, clinical re-evaluation should be repeated at three and six months or deferred until the prevalence of SARS-CoV-2 has significantly decreased

• Diagnostic pathways may need to be very different from usual recommendations in order to reduce investigations

• When extensive differential diagnostic testing is not feasible, it should be deferred, and medical treatment should be initiated

• Transsphenoidal pituitary surgery may be avoided during high SARS-CoV-2 viral prevalence

• Medical management rather than surgery will be the used for most patients since the short- to mid-term prognosis depends in most cases on hypercortisolism rather than its cause; it should be initiated promptly to minimize the risk of infection in these immunosuppressed patients

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