Post COVID-19 Lymphocytic Hypophysitis: A Rare Presentation

Abstract

Introduction: Lymphocytic hypophysitis (LH) is a rare autoimmune disorder involving the destruction of the anterior pituitary due to lymphocytic infiltration. The disease shows a female predominance, commonly affecting women during late pregnancy into the postpartum period. The etiology of LH has not been well established and is presumed to be autoimmune based on the histopathological findings of lymphocytic infiltration and postpartum cases. Lymphocytic hypophysitis has yet to be studied in the context of a patient status post-recovery from COVID-19. Since the initial outbreak, additional information regarding the symptoms and outcomes has emerged on the virus's effects on the nervous system. Case: We present a novel case of post-COVID lymphocytic hypophysitis in a pediatric patient at Dayton Children's Hospital. An 18-year-old previously healthy girl presented to the emergency department (ED) with acute onset headache and dizziness for 5 days. She had a history of symptomatic COVID-19 three weeks prior to the onset of current symptoms. Contrast enhanced magnetic resonance imaging (MRI) of the brain revealed diffuse thickening and enlargement of the infundibulum with homogenous contrast enhancement of the hypophyseal axis. Based on the suspicion for lymphocytic hypophysitis, she was started on Methylprednisolone 250 mg IV Q6hrs on day 1-3. Symptomatic clinical improvement was seen on day 3 with a significant decrease in the intensity of the headache. Conclusion: The case illustrates the varied presentation and neurological sequalae associated with the COVID-19 virus. The case described here is the first ever reported post-COVID manifestation of lymphocytic hypophysitis.

Coronavirus as a trigger of lymphocytic hypophysitis in an adolescent girl: An exceptional case report

“…There are numerous reports on the increased incidence of several autoimmune endocrine diseases with novel associations with SARS-COVID 19 including Graves' disease, atypical thyroiditis with characteristic features of autoimmune thyroiditis, pituitary apoplexy, and lymphocytic hypophysitis [ [8] , [9] , [10] , [11] , [12] ]. Overall, there are four reported cases of post-COVID-19 hypophysitis.…”

“…The present patient had central diabetes insipidus without any other endocrine disorders. However, our review of the four previous cases of autoimmune hypophysitis post-COVID-19 described hypopituitarism or central diabetes insipidus in three patients ( Table 2 ) [ 10 , 12 , 16 ]. It has been established that there was a predominant failure of thyroid and adrenal functions in hypophysitis, while GH and gonadotropin secretion would be affected to a slight degree [ 1 , 20 , 21 ].…”

Secondary hypophysitis associated with Rathke’s cleft cyst resembling a pituitary abscess

“…Similar to our patient, these cases related to SARS-CoV-2 infection and vaccination presented with headaches and hormonal disturbances, pituitary stalk thickening, and pituitary gland enlargement on imaging, and they responded well to steroid treatment. [ 2 , 18 , 21 , 25 , 27 , 28 , 32 , 45 ] There is no conclusive evidence yet showing that either SARS-CoV-2 infection or vaccination causes hypophysitis. However, the authors have hypothesized that SARS-CoV-2 might directly invade the central nervous system through the cribriform plate or by hematogenous dissemination.…”

Unveiling the Etiopathogenic Spectrum of Hypophysitis: A Narrative Review

“…The transport of the COVID-19 virus to the brain and pituitary via the cribriform plate near the olfactory bulb may provide an additional route that allows the virus to reach and impact the brain [76,78,80] (Figure 3). Thus, the proinflammatory properties leading to hypophysitis could be accounted for via the direct targeting of hypothalamic and pituitary tissues due to high expression of ACE2 receptors [12,76,80]. However, theoretically, the effect of SARS-CoV-2 on the function of the hypothalamic-pituitary axis could occur indirectly through inflammation and the release of cytokines [77,81].…”

“…Lastly, since the resolution of hypophysitis is usually achieved with the administration of glucocorticoids, widely used for treating patients with COVID-19, it could be hypothesized that such therapy may result in a reduced or stable incidence of hypophysitis in patients with COVID-19 [76]. Thus, the proinflammatory properties leading to hypophysitis could be accounted for via the direct targeting of hypothalamic and pituitary tissues due to high expression of ACE2 receptors [12,76,80]. However, theoretically, the effect of SARS-CoV-2 on the function of the hypothalamic-pituitary axis could occur indirectly through inflammation and the release of cytokines [77,81].…”