Rare case of COVID-19 vaccine-induced hypophysitis in a woman with central manifestations of diabetes insipidus

The 2019 coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had an adverse public health impact worldwide, resulting in millions of deaths. Vaccination is considered the most effective intervention in reducing COVID-19-related serious illness and death.

background

Systemic and local side effects were common, especially after the second vaccination. These include headache, malaise, fever, arthralgia, and myalgia. However, these side effects are moderate or mild and last about two days after vaccination. Previous research has pointed to some cases of isolated pituitary abnormalities such as hypophysitis.

Hypophysitis is a rare and chronic inflammatory disease of the pituitary gland that causes hormone deficiency in the anterior and/or posterior pituitary and structural changes in the hypothalamic-pituitary axis. This condition is very heterogeneous and can be caused by multiple medical treatments.

A recent study reported cases of pituitary lesions associated with COVID-19 vaccination. However, there is still no data on the occurrence of hypophysitis. In addition, this was the fourth reported case of hypophysitis following SARS-CoV-2 vaccination and the second associated with central diabetes insipidus.

A new study to be published in therapies The purpose of the journal was to analyze a rare case of hypophysitis caused by thickening of the pituitary stalk three days after the administration of the SARS-CoV-2 vaccine.

About the study

The study involved a 54-year-old woman who had been previously diagnosed with high blood pressure and treated with a calcium channel blocker. She reported no family or personal history of COVID-19, endocrine disorders, autoimmune disorders, or upper respiratory tract infections. Three days after receiving the first SARS-CoV-2 vaccine (Oxford-AstraZeneca ChAdOx1 nCoV-19), she reported the onset of nocturia and polyuria of almost 10 liters per day.

After that, she underwent multiple tests that included blood pressure, body mass index (BMI), osmolarity, vasopressin provocation, total blood count, antinuclear antibodies, liver function, endocrine function, chest radiography, cortisol stimulation, and water deprivation test. Finally, the diagnosis of central diabetes insipidus (DI) was made, followed by magnetic resonance imaging (MRI) of the pituitary stalk.

study results

The results showed that her blood pressure was 130/70 mmHg, pulse rate was 90 beats per minute, BMI was 36 kg/m², plasma osmolarity and serum sodium were high (305.8 mosmol/kg and 151 mmol/kg, respectively). l). ) and urinary osmolarity were low (138 mosmol/kg). The water deprivation test had to be stopped after the third hour due to excessive thirst intolerance. In addition, it was observed that urinary osmolarity did not increase above 200 mosmol/kg in 3 hours regardless of a 1 kg weight loss.

DI diagnosis was confirmed by urine output and vasopressin challenge test. In addition, MRI of the pituitary stalk showed a 5.05 mm thickening in the transverse dimension, suggesting infundibuloneurohypophysitis. Serum levels of angiotensin converting enzyme, β2-microglobulin and IgG4 have been reported as normal. Results of chest x-ray, complete blood count, liver function, endocrine function, and antinuclear antibody tests were also reported as normal. In addition, treatment with oral desmopressin at 60 mg/day showed a reduction in thirst, and complete remission of DI symptoms was observed at 120 mg/day.

Conclusion

Therefore, the current study suggests that the onset of hypophysitis is caused by adjuvants of the SARS-CoV-2 vaccine in the absence of evidence for all other potential etiologies. More research needs to be done on the autoimmune and endocrine effects of the mRNA COVID-19 vaccine to prevent such side effects.