Doctors issue warning over hormone disorder Covid-19 vaccination risk

Darragh Mc Donagh

Doctors have recommended that patients with certain hormone disorders should be warned that they are at risk of becoming unwell following Covid-19 vaccination after two people were hospitalised with life-threatening conditions.

A woman in her 80s and a man in his 70s attended an emergency department with a range of symptoms, including dizziness, vomiting, lethargy, and confusion after receiving a vaccine for Covid-19.

They both had a history of Addison’s disease, which is an endocrine disorder causing the adrenal glands to produce insufficient quantities of the steroid hormones, cortisol and aldosterone.

Doctors found that they were both in adrenal crisis, which is a medical emergency and life-threatening complication of Addison’s disease. They were treated with intravenous steroids and fluids.

The details were contained in a case report by doctors at St. Vincent’s Hospital in Dublin and Midlands Regional Hospital in Mullingar, which was published in the latest issue of the Irish Medical Journal.

They noted that there had been other cases in which Covid-19 vaccination had precipitated adrenal crises in steroid-dependent patients who had been on steroid replacement therapy for long periods.

The authors said vaccination was recommended for high-risk patients, including those with Addison’s disease or adrenal insufficiency.

However, they said there were no guidelines advising increasing doses of steroids around vaccination for these patients.

“Patients who have been previously treated for post-vaccination adrenal crisis may be at risk of adrenal crisis with future vaccinations and adrenal crisis may affect those with either primary or secondary adrenal insufficiency,” the doctors wrote.

They said steroid-dependent patients, such as those with Addison’s disease, should be alerted to the possibility that they may become unwell following vaccination. Increased awareness of this risk may help maintain confidence in the vaccination programmes, they added.

The woman in her 80s had begun to feel unwell around 12 hours after getting the Covid-19 jab. She received intravenous fluids and steroids, and was discharged after one day.

The man in his 70s, who was steroid-dependent and had a history of adrenal insufficiency was discharged after two days. It was his third episode of feeling unwell after Covid-19 vaccination. He required intravenous steroids on each occasion.

“For other steroid-dependent patients, it may be beneficial to alert them to the possibility that they may become unwell following vaccination, educate them on sick day rules, and to make them aware of when to seek medical attention,” the authors concluded.