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

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...

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Autores principales: Aliberti, Ludovica, Gagliardi, Irene, Rizzo, Roberta, Bortolotti, Daria, Schiuma, Giovanna, Franceschetti, Paola, Gafà, Roberta, Borgatti, Luca, Cavallo, Michele A., Zatelli, Maria C., Ambrosio, Maria R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712198/
https://www.ncbi.nlm.nih.gov/pubmed/36465651
http://dx.doi.org/10.3389/fendo.2022.1035482
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author Aliberti, Ludovica
Gagliardi, Irene
Rizzo, Roberta
Bortolotti, Daria
Schiuma, Giovanna
Franceschetti, Paola
Gafà, Roberta
Borgatti, Luca
Cavallo, Michele A.
Zatelli, Maria C.
Ambrosio, Maria R.
author_facet Aliberti, Ludovica
Gagliardi, Irene
Rizzo, Roberta
Bortolotti, Daria
Schiuma, Giovanna
Franceschetti, Paola
Gafà, Roberta
Borgatti, Luca
Cavallo, Michele A.
Zatelli, Maria C.
Ambrosio, Maria R.
author_sort Aliberti, Ludovica
collection PubMed
description 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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spelling pubmed-97121982022-12-02 Pituitary apoplexy and COVID-19 vaccination: a case report and literature review Aliberti, Ludovica Gagliardi, Irene Rizzo, Roberta Bortolotti, Daria Schiuma, Giovanna Franceschetti, Paola Gafà, Roberta Borgatti, Luca Cavallo, Michele A. Zatelli, Maria C. Ambrosio, Maria R. Front Endocrinol (Lausanne) Endocrinology 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. Frontiers Media S.A. 2022-11-17 /pmc/articles/PMC9712198/ /pubmed/36465651 http://dx.doi.org/10.3389/fendo.2022.1035482 Text en Copyright © 2022 Aliberti, Gagliardi, Rizzo, Bortolotti, Schiuma, Franceschetti, Gafà, Borgatti, Cavallo, Zatelli and Ambrosio https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Aliberti, Ludovica
Gagliardi, Irene
Rizzo, Roberta
Bortolotti, Daria
Schiuma, Giovanna
Franceschetti, Paola
Gafà, Roberta
Borgatti, Luca
Cavallo, Michele A.
Zatelli, Maria C.
Ambrosio, Maria R.
Pituitary apoplexy and COVID-19 vaccination: a case report and literature review
title Pituitary apoplexy and COVID-19 vaccination: a case report and literature review
title_full Pituitary apoplexy and COVID-19 vaccination: a case report and literature review
title_fullStr Pituitary apoplexy and COVID-19 vaccination: a case report and literature review
title_full_unstemmed Pituitary apoplexy and COVID-19 vaccination: a case report and literature review
title_short Pituitary apoplexy and COVID-19 vaccination: a case report and literature review
title_sort pituitary apoplexy and covid-19 vaccination: a case report and literature review
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712198/
https://www.ncbi.nlm.nih.gov/pubmed/36465651
http://dx.doi.org/10.3389/fendo.2022.1035482
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