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COVID-19 During Diagnosis

Question: I suspect I have hypercortisolism but now I’m concerned about delays, unavailability of tests or medicines, and exposure to the virus during lots of doctor appointments. What can I do to safely get a diagnosis? Would waiting out this period be harmful?

Answer 1:  For most places, I expect the cancellation of non-emergency testing, etc. to last up to 12 weeks.  I think checking with local docs is the safest thing to do, but given my expectation of two to three months “freeze”, it is probably not appropriate to do anything else although every patient is different, which is why checking with the local docs is the most appropriate thing to do.  (Dr. Constantine Stratakis, NIH)

Answer 2:  It is quite understandable that patients with suspected hypercortisolism (Cushing’s syndrome) wish to receive a diagnosis and treatment as soon as possible. However, visits to the doctor or the laboratory can potentially expose patients to COVID-19 infection. In addition, patients with active hypercortisolism may be at higher risk of infection in general. It would be prudent for patients to discuss with their physicians whether they should defer office visits and testing while there is substantial risk of COVID-19 infection in the community. In many cases, a delay of a few weeks or even a few months is unlikely to be harmful.  (Dr. Nicholas Tritos, Mass General)

Answer 3:  First, if you have conditions that are associated with Cushing’s syndrome, like high blood pressure or diabetes, be sure that you continue to take your medications for these conditions.  In terms of getting a diagnosis, this is not an ideal time to be around sick patients, so multiple visits to an office or hospital should be avoided.  However, if the symptoms are severe and you have not been evaluated for the possibility of associated conditions, or for CS itself, then the risk of waiting may be worse than the risk of pursuing the diagnosis.  It is not possible to say which risk is more without knowing more about an individual patient.  If you have a primary care physician, one option is to call the office and see if there is a possibility of a phone or televideo consultation about your symptoms.  This would allow your doctor to judge whether to go ahead.  Three tests are used to make the diagnosis of CS:  measurement of cortisol in a urine sample collected at home for 24 hours; measurement of cortisol in saliva collected at home at bedtime; measurement of cortisol in a blood sample collected in the morning after taking dexamethasone, 1 mg, at home between 11pm and midnight the previous day.  Often the collection containers can be picked up at the doctor’s office or the laboratory, and returned, with minimal interaction with other people. The dexamethasone can be picked up at a pharmacy and the blood collected at the doctor’s office or laboratory.  A number of physicians and laboratories are taking steps to reduce patient contact (physical distancing), for example, having patients wait in their car until an examination room is available.  The best thing is to contact your physician for advice.  (Dr. Lynnette Nieman, NIH)

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