Pituitary apoplexy after COVID-19 vaccination: A case report

Zainordin, Nur Aisyah; Hatta, Sharifah Faradila Wan Muhammad; Mumin, Nazimah Ab; Shah, Fatimah Zaherah Mohd; Ghani, Rohana Abdul

doi:10.1016/j.jecr.2022.100123

Cited by 13 publications

(19 citation statements)

References 11 publications

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“…Biochemistry detected secondary hypocortisolism, therefore intravenous hydrocortisone was started with symptom improvement and significant 50% reduction in size of the pituitary mass. Authors concluded that the patient might have developed an exaggerated immunological response after the vaccine with a possible hypophysitis leading to a pituitary apoplexy ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Pituitary apoplexy and COVID-19 vaccination: a case report and literature review

et al. 2022

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A 50-year-old man was admitted to our hospital for vomit, nausea, diplopia, and headache resistant to analgesic drugs. Symptoms started the day after his third COVID-19 mRNA vaccine (Moderna) whereas SARS-CoV-2 nasal swab was negative. Pituitary MRI showed recent bleeding in macroadenoma, consistent with pituitary apoplexy. Adverse Drug Reaction was reported to AIFA (Italian Medicines Agency).A stress dexamethasone dose was administered due to the risk of adrenal insufficiency and to reduce oedema. Biochemistry showed secondary hypogonadism; inflammatory markers were elevated as well as white blood cells count, fibrinogen and D-dimer. Pituitary tumour transsphenoidal resection was performed and pathology report was consistent with pituitary adenoma with focal haemorrhage and necrosis; we found immunohistochemical evidence for SARS-CoV-2 proteins next to pituitary capillaries, in the presence of an evident lymphocyte infiltrate.Few cases of pituitary apoplexy after COVID-19 vaccination and infection have been reported. Several hypotheses have been suggested to explain this clinical picture, including cross-reactivity between SARS-CoV-2 and pituitary proteins, COVID-19-associated coagulopathy, infection-driven acutely increased pituitary blood demand, anti-Platelet Factor 4/heparin antibodies development after vaccine administration. Ours is the first case of SARS-CoV-2 evidence in pituitary tissue, suggesting that endothelial infection of pituitary capillaries could be present before vaccination, possibly due to a previous asymptomatic SARS-CoV-2 infection. Our case underlines that SARS-CoV-2 can associate with apoplexy by penetrating the central nervous system, even in cases of negative nasal swab. Patients with pituitary tumours may develop pituitary apoplexy after exposure to SARS-CoV-2, therefore clinicians should be aware of this risk.

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Section: Discussionmentioning

confidence: 99%

Pituitary apoplexy and COVID-19 vaccination: a case report and literature review

et al. 2022

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“…Pituitary apoplexy has also been reported after vaccination [134] , [135] . However, the causal link between COVID-19 vaccination and the above-mentioned types of pituitary dysfunction cannot be conclusively established based on these rare case reports.…”

Section: Pituitary Pathology In the Context Of Covid-19mentioning

confidence: 98%

Pituitary and SARS CoV-2: An unremitting conundrum

Căpățînă

Poiană

Fleseriu

2023

Best Practice & Research Clinical Endocrinology & Metab

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“…SC2V-related cerebrovascular diseases include VST, ischemic stroke, ICH, SAB, pituitary apoplexy, RCVS, cerebral vasculitis, and Susac syndrome ( Table 2 ) [ 4 , 6 …”

Section: Resultsmentioning

confidence: 99%

Neurological Adverse Reactions to SARS-CoV-2 Vaccines

Finsterer¹

2023

Clin Psychopharmacol Neurosci

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SARS-CoV-2 vaccines are not free of side effects and most commonly affect the central or peripheral nervous system (CNS, PNS). This narrative review aims to summarise recent advances in the nature, frequency, management, and outcome of neurological side effects from SARS-CoV-2 vaccines. CNS disorders triggered by SARS-CoV-2 vaccines include headache, cerebro-vascular disorders (venous sinus thrombosis [VST], ischemic stroke, intracerebral hemorrhage, subarachnoid bleeding, reversible, cerebral vasoconstriction syndrome, vasculitis, pituitary apoplexy, Susac syndrome), inflammatory diseases (encephalitis, meningitis, demyelinating disorders, transverse myelitis), epilepsy, and a number of other rarely reported CNS conditions. PNS disorders related to SARS-CoV-2 vaccines include neuropathy of cranial nerves, mono-/polyradiculitis (Guillain-Barre syndrome [GBS]), Parsonage-Turner syndrome (plexitis), small fiber neuropathy, myasthenia, myositis/dermatomyositis, rhabdomyolysis, and a number of other conditions. The most common neurological side effects are facial palsy, intracerebral hemorrhage, VST, and GBS. The underlying pathophysiology is poorly understood, but several speculations have been generated to explain the development of CNS/PNS disease after SARS-CoV-2 vaccination. In conclusion, neurological side effects develop with any type of SARS-CoV-2 vaccine and are diverse, can be serious and even fatal, and should be taken seriously to initiate early treatment and improve outcome and avoid fatalities. KEY WORDS: Side effects; COVID-19 vaccination; Neurological; Brain; Nerves."venous sinus thrombosis", "multiple sclerosis", "acute disseminated encephalomyelitis", "seizure", "Guillain Barre syndrome", "Parsonage Turner syndrome", "myositis", and "myasthenia". In addition, reference lists were searched for additional articles that matched the search criteria. Neurological COVID Vaccination Complications 223Table 1. Most common marketed anti-SARS-CoV-2 vaccines Company Generic name Brand name Ⓡ Technology Number of dosages Biontech Pfizer BNT162b2 Comirnaty m-RNA Two/booster Moderna m-RNA1273 Spikevax m-RNA Two/booster Astra Zeneca ChAdOx1-S nCoV-19 Vaxzevira Viral vector Two/booster Curevac CVnCoV Zorecimeran m-RNA Two Novavax NVX-Cov2373 Novaxovid Protein subunit Two Johnson & Johnson Ad26.COV.2S Jcovden Viral vector One Sinovac CoronaVac CoronaVac Viral vector Two/booster Valneva VLA2001 COVID-19 vaccine Viral vector Two/booster Sinopharm COVID 2019 vaccine BIBP Viral vector Two/booster Gam-Covid-Vac Sputnik-V Gam-Covid-Vac Viral vector Two Bharat Biotech BBV152 Covaxin Viral vector Two/booster CanSino Biologics Ad5-nCoV Convidecia Viral vector Single Sinopharm BBIBP32-CorV Covilo Viral vector Two booster Sanofi Pasteur VidPrevtyn beta VidPrevtyn beta Protein subunit OneOriginal articles and reviews published between 1966 and December 2022 were included. Abstracts, proceedings, and editorials were excluded from data analysis. The review does not claim to be complete, since the number of words and references was...

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Pituitary apoplexy after COVID-19 vaccination: A case report

Cited by 13 publications

References 11 publications

Pituitary apoplexy and COVID-19 vaccination: a case report and literature review

Pituitary apoplexy and COVID-19 vaccination: a case report and literature review

Pituitary and SARS CoV-2: An unremitting conundrum

Neurological Adverse Reactions to SARS-CoV-2 Vaccines

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