Here are some answers to common questions about coronavirus from Pauline, our Endocrine Nurse. We will continue to monitor the situation and will share any further advice we receive.
How will this affect me?
Your general routine will be affected by the restrictions being put in place on travel and large events/gatherings and the closures of recreational venues.
As with the general advice given by the government you should take extra care to wash your hands with soap and water for at least 20 seconds, regularly throughout the day. This is especially important to do on your return home from any outside excursion. https://youtu.be/bQCP7waTRWU
Avoid touching your eyes, nose and mouth with hands that have not been washed if you have been shopping, using public transport etc. If you do cough or sneeze then use the crook of your elbow/sleeve to ‘catch’ this. If you use tissues then immediately place the tissue in a bin and wash hands after use.
If you're not able to wash your hands, sanitiser gel can be used until you have access to soap and water.
Are all pituitary patients at risk as we have a rare disease?
Those pituitary patients most at risk are those with active Cushing’s disease (much higher than normal cortisol level) and those who need to take cortisol replacements (lower than normal cortisol level). These groups should stay at home as much as possible and follow strict social distancing practices.
DI patients don’t fall within an at risk category, but can become vulnerable if virus/illness contracted. If a patient with DI has other conditions i.e. Adrenal Insufficiency (vulnerable), diabetes, asthma (at risk) then their overall risk is raised as indicated in the brackets. The links below may be of use.
For those patients with prolactinoma, acromegaly, non-functioning adenoma & NO STEROIDS NEED REPLACING there is no increased risk but practise strict safe social distancing like all population.
If any patient has other medical conditions e.g. asthma, diabetes, heart failure, is over the age of 70yrs then they are also indicators of a higher risk.
How is this virus spread?
As it is a new illness work is still underway to discover exactly how coronavirus spreads from person to person. Similar viruses are spread by cough droplets.
Do I need to increase my steroid replacement to prevent becoming infected?
No, you should continue to take your steroid replacement as normal, only increasing dose if you begin to develop signs of infection: cough, raised body temperature, shortness of breath, aches, pains.
How will I know if I have this specific virus (Covid-19)?
The only accurate way is by having swabs taken from your nose and throat, along with sample of any sputum you may be producing. These are then analysed in several specialist laboratories set up specifically for this purpose.
Early signs are similar to those for many other viruses: cough, shortness of breath, increased body temperature, feeling achy/muscle pains and headaches. If these develop you should follow your normal sick day rules and use Paracetamol to help with controlling fever and pain.
You should also isolate at home for 7 days, and this may mean sleeping in a separate room. You should aim to stay 2-3 steps separated from anyone else and you should avoid the vulnerable groups of the elderly and immunocompromised.
All other family members should self isolate with you for a period of 14 days as they are at risk of having contracted the virus.
You should then only contact NHS 111 online if your symptoms worsen during your 7 day isolation or if they have not resolved by the end of 7 days. If you have no internet access then call NHS 111.
If you are becoming weaker or it is taking an excessive amount of time to make contact, call 999 and state adrenal insufficiency and describe your symptoms.
What should I do with my steroid replacement?
You should continue with your standard doses and only increase if you show signs of infection.
You should then follow the normal ‘sick day’ rules
Should I be taking Cortisol - isn’t it an anti-inflammatory?
Your cortisol replacement is to replace what you can no longer make for yourself.
We all need the hormone cortisol to keep our bodies fully functioning, without it we cannot sustain life. In times of stress to the body – illness, infection, accident etc we need an increase in cortisol to help meet the demands to cope with that stress.
Levels of cortisol to give anti-inflammatory effects are generally much higher than those you will take as replacement doses.
You should therefore continue to use your steroid replacement as instructed by your Endocrine team on a day to day basis, increasing the doses in line with the ‘sick day’ rules if you become unwell
Will I need to use my hydrocortisone injection?
It is unlikely that you will need to use your injection. Currently most cases of the virus are similar to the usual ‘flu viruses we see each winter, so increasing your tablet replacement should suffice.
Your injection should be used in these circumstances:
- An increase in your standard steroid tablets has not helped
- Symptoms are worsening and body temperature is increasing
If you use your injection then you should contact NHS 111 immediately for advice on further treatment or further medical review. If making contact is taking too long or you are becoming weaker then call 999 and state adrenal insufficiency and outline your symptoms.
I am designated as a key worker – should I still be going to work?
If you are a pituitary patient that needs cortisol replacement then you should be following very strict social distancing practices. Should you contract the virus your ability to combat it is significantly impaired and increases in cortisol doses will be needed. If patients with diabetes insipidus were to contract the virus, there could be problems maintaining a level fluid balance and so a disruption to sodium control.
Wherever possible you should aim to work from home, if you are in healthcare, nursery or school work however this can be difficult. You may need to speak with your manager about redefining your role at work so that you can be removed from direct contact with service users as much as possible. Or look to establish a system by which you can maintain a 2 metre separation.
Should I limit mixing with people/going out?
In line with latest Government advice you should aim to work from home wherever possible.
Restrict leaving the home to essential need only, e.g. food shopping, prescription collecting.
Do not visit elderly or vulnerable relatives or have them visit you, instead keep in touch by telephone or social media.
When you do go out avoid large groups of people, maintain a 2 metre separation from others and limit public transport use.
Wash hands immediately on returning home
What is self-isolation?
This is staying at home, away from other people.
If you are confirmed as being infected with or have symptoms of this current coronavirus you should not go for walks, use public transport or taxis or visit public places.
If you are self-isolating due to a family member being infected with coronavirus you should follow this advice too
Any personal waste such as used tissues should be disposed of in a sealed disposable rubbish bag. This bag should then be placed into a second bag, tied securely and separated from other waste in the self-isolation area. The bags should be kept aside for 72hrs after which time they can be disposed of in the normal household external bin.
You should make plans to have contact people- local groups, family or friends that could shop and drop off for you. Remember they should not enter the home, but leave any shopping at the door for you to collect.
Keep in touch with family and friends by telephone or via social media https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-people-with-confirmed-or-possible-coronavirus-covid-19-infection
So which pituitary patients should self isolate for 12 weeks?
To date the government advice is for ALL of us to follow strict social distancing practices.
At present there is no advice for pituitary patients to self isolate unless they also fit into the list outlined by the government on 22/3/2020
All people in ‘At Risk and Vulnerable ’ groups, into which steroid dependent patients fall should be following very strict social distancing. The link below gives more detail on this. There is also information for households to follow with regard to protecting family members living with you.
What extra measures should I take?
Ensure you have an extra supply of your steroid replacement to enable you to have an increased dose.
Ensure you have sufficient supplies of all other medications to cover any self-isolation period
Check your hydrocortisone injection is in date and easily to hand should it be needed
Further information is available from the links below.