Central diabetes insipidus: a late sequela of BNT162b2 SARS-CoV-2 mRNA vaccine?

Abstract

Background The development of an effective vaccine is a powerful tool to contain the global spread of coronavirus disease 2019 (COVID-19). Still, it raises potential safety concerns about the subsequent enhancement of associated immunopathology. Increasing evidence shows that the endocrine system, including the hypophysis, may be involved in COVID-19. Moreover, occasional but increasing reports of endocrine disorders involving the thyroid have been reported after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Among them, a few cases encompass the pituitary. Here we report a rare case of central diabetes insipidus following SARS-CoV-2 vaccination. Case presentation We report a 59-year-old female patient with a 25-year history of Crohn's disease in long-term remission, who presented with sudden onset of polyuria eight weeks after administration of an mRNA SARS-CoV-2 vaccination. Laboratory evaluation was consistent with isolated central diabetes insipidus. Magnetic resonance imaging displayed involvement of the infundibulum and the posterior hypophysis. Eighteen months after the vaccination, she is still under desmopressin treatment and had stable pituitary stalk thickening on magnetic resonance imaging. Although Crohn's disease-associated hypophysitis has been reported, it is scarce. In the absence of other recognizable causes of hypophysitis, we believe the involvement of the hypophysis in our patient may have been triggered by the SARS-CoV-2 vaccine. Conclusions We report a rare case of central diabetes insipidus potentially associated with SARS-CoV-2 mRNA vaccination. Further studies are needed to understand better the mechanisms underlying autoimmune endocrinopathies development in the context of COVID-19 infection and SARS-CoV-2 vaccination.

Hypopituitarism with secondary adrenocortical insufficiency and arginine vasopressin deficiency due to hypophysitis after COVID-19 vaccination: a case report

“…There is no description of the recovery of hormone levels in the three previous cases of hypopituitarism induced by COVID-19 vaccines [ 11 – 13 ]. In some cases of AVP deficiency, long-term replacement of vasopressin is necessary [ 6 – 8 , 11 ]. Nevertheless, it is also reported that in about half cases of thyroid disorder, at least partial recovery was observed within 5 months [ 11 ], indicating a relatively better prognosis in ASIA than other etiologies.…”

A Narrative Review of Neurological Complications of SARS-CoV-2 Vaccination

“…However, CDI from Pfizer vaccine may take 8 weeks to develop. 81 Improvement in pituitary function follows hormonal replacement.…”

SARS-CoV-2 Vaccines-Related Endocrine Disorders: An Updated Narrative Review

“…Most of these patients had no previous known pituitary disease or SARS-CoV-2 infection. The median time between vaccination and the onset of pituitary disorder was 3 days and ranged from one [85][86][87][88] to sixty days [89]. Description of the reported cases are summarized in supplementary Table 1.…”

“…Concerning hypophysitis, this is a sporadic disease with an incidence of ~1 in 9 million/year in the form of primary hypophysitis [96]. Hypophysitis following SARS-CoV-2 vaccine present most often as isolated arginine vasopressin (AVP) deficiency (central diabetes insipidus) due to infundibuloneurohypophysitis [89,[97][98][99]. AVP deficiency was also reported with subsequent development of optic neuritis [100].…”

“…Similarly, activation of the renin-angiotensin system by ACE receptor downregulation is one of the possible mechanisms in developing endocrine dysfunction following the COVID-19 vaccine [4,5]. A recent systematic review confirmed the safety of the four most efficacious COVID-19 vaccines [6], 2 even if a few severe adverse events, including endocrine dysfunction, have been reported [7].…”