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COVID-19 and Surgery

Question:  I’ve been diagnosed with Cushing’s but I’m scared to have the surgery right now.  It seems like most of the bigger centers with experienced surgeons are located in cities that are “hot spots” for the virus.  What advice is there for someone in my situation?

Answer 1:  Checking with the local docs is the most appropriate thing to do.  Every patient is different, but in most cases surgery can be postponed for a few weeks.  However, one has to weigh this against immunocompromise while sick with CS. (Dr. Constantine Stratakis, NIH)

Answer 2:  In many hospitals, elective surgical procedures have been placed on hold by hospital administrators because of concern for a surge in hospital admissions in light of COVID-19. It is also true that the virus is more likely to be prevalent in larger cities where most of the academic hospitals are located. In all cases, patients should talk to their doctors about medical treatment options before surgery, if their operation is being delayed. Although not curative, medications can ameliorate hypercortisolism which may help improve patients’ symptoms and potentially reduce their risk of contracting infection.  (Dr. Nicholas Tritos, Mass General)

Answer 3:  In many cities, “elective” surgery (that can be postponed) is being cancelled.  It is important to have surgery with a surgeon who has experience with the procedure, so it is possible that the recommended surgeon will be in a “hot spot.”  (It is also likely that much of the country will become a “hot spot”)  Your endocrinologist and/or surgeon should be consulted to decide how urgent it is to perform surgery.  If you are taking medication for associated conditions, like hypertension or diabetes, continue to take those medications.  If surgery is not possible, your endocrinologist might prescribe additional medication to help reduce the cortisol levels or block the action of cortisol.  This might allow you to wait until the surgery is available.  (Dr. Lynnette Nieman, NIH)

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