Adrenal crisis following COVID-19 vaccination in steroid dependant patients assessed in the Emergency Department

Abstract

Introduction
Two patients with adrenal insufficiency presented to the Emergency Department (ED) following vaccination against COVID-19.

Cases
Case 1, presented with dizziness, lethargy, confusion and feeling generally unwell. Case 2, presented with fever, vomiting, dizziness, malaise and feeling generally unwell. Both patients reported feeling well in the days prior to vaccination.

Outcome
No infection was found and both patients were treated as an adrenal crisis and managed with intravenous steroids and fluids. Both patients were referred to the medical team for admission. Case 1 was discharged 1 day later. Case 2 was discharged 2 days later.

Discussion
Vaccination is recommended for high-risk patients, including patients with adrenal insufficiency to prevent severe illness. There are currently no guidelines advising routine stress dosing of steroids around vaccination for these high-risk patients. This may be beneficial for these patients when weighing the risks and benefits in conjunction with the patient’s history and with advice from their Endocrinologist.