Outpatient management of endocrine conditions during the COVID-19 pandemic

Abstract

Still very active COVID-19 pandemic demands continuous adjustment of our regular practices of delivering patient care. The aim of this manuscript is to provide practical suggestions for the management of the most common endocrinological conditions during ongoing COVID-19/SARS-CoV2 pandemic. We have conducted a literature review and present our own experience of treating endocrinology patients during the months of full COVID-19 lockdown and then phased partial reopening. The results of the literature review have demonstrated the utmost importance of excelling in a challenging task of maintaining the best possible control of such endocrinological conditions as diabetes mellitus and adrenal insufficiency, while also maintaining the universal social distancing and isolation. In the patients with diabetes mellitus Hemoglobin A1C level correlates with the risk of unfavorable outcomes of COVID-19 which makes optimization of diabetes mellitus control an even more significant during the pandemic. It is important to provide the patients with the specific instructions on self-titration of insulin and on the use of non-insulin antidiabetic medications, examples of which are shown in the manuscript. For the patients with adrenal insufficiency, it is essential to discuss the rules of dose increase of the glucocorticosteroids in case of development of COVID-19 or any other acute illness. The diagnosis and management of other endocrinological conditions as for example thyroid nodules and osteoporosis (with the exclusion of secondary osteoporosis associated with diseases requiring timely treatment) can be delayed for the sake of everybody's safety and partially also for prioritization of healthcare recourses utilization during these uneasy times. Since the beginning of the pandemic a considerable amount of new information regarding theoretical and practical aspects of connection of SARSCoV2 and endocrinology is emerging almost weekly. In this manuscript, we have tried to gather the most clinically relevant data on the outpatient management of the patients with endocrine pathology.