Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Department of Nephrology, Centro Hospitalar do Médio Tejo, Torres Novas, Portugal.
Front Endocrinol (Lausanne). 2022 May 4;13:889074. doi: 10.3389/fendo.2022.889074. eCollection 2022.
Cases of central diabetes insipidus (CDI) have been reported after COVID-19 infection, with hypophysitis being the most likely cause. COVID-19 vaccines potential adverse effects may mimetize some of these complications.
Woman 37 years old, with rheumatoid arthritis under adalimumab (40 mg twice a month) since December 2018. She was in her usual state of health when she has received the second dose of BNT162b2 mRNA COVID-19 vaccine (June 2021). Seven days later, she started reporting intense thirst and polyuria and consulted her family physician.
creatinine 0.7 mg/dL, glucose 95mg/dL, Na+ 141mEq/L, K+ 3.9 mEq/L, TSH 3.8 mcUI/L (0.38-5.33), FT4 0.9 ng/dL (0.6-1.1), cortisol 215.4 nmol/L (185-624), ACTH 21.9 pg/mL (6- 48), FSH 4.76 UI/L, LH5.62 UI/L, estradiol 323 pmol/L, IGF1 74.8 ng/mL (88-209), PRL 24.7mcg/L (3.3-26.7) osmolality 298.2 mOs/Kg (250- 325); Urine analysis: volume 10200 mL/24h, osmolality 75 mOs/Kg (300-900), density 1.002. On water restriction test: 0' - Serum osmolality 308.8mOsm/Kg vs. urine osmolality 61.0 mOsm/Kg; 60' - urine osmolality 102 mOsm/Kg; urine osmolality 1 h after desmopressine was 511mOsm/kg. MRI revealed no abnormal signs consistent with hypophysitis except for the loss of the posterior pituitary bright spot on T1 weighted imaging. Diagnosis of CDI was assumed, and started therapy with desmopressine. A report of potential adverse effect was addressed to national health authorities.
In hypophysitis MRI often shows loss of posterior pituitary bright spot on T1 weighted imaging, pituitary enlargement or stalk thickening but those findings were not present in this patient. To the best of our knowledge, CDI has never been reported following administration of a COVID-19 vaccine.
有报道称 COVID-19 感染后会出现中枢性尿崩症（CDI），垂体炎是最可能的原因。COVID-19 疫苗的潜在不良反应可能模拟这些并发症中的一些。
一名 37 岁女性，自 2018 年 12 月起接受阿达木单抗（40mg，每月两次）治疗类风湿关节炎。她在接受 BNT162b2 mRNA COVID-19 疫苗第二剂（2021 年 6 月）后身体状况良好。7 天后，她开始出现极度口渴和多尿，并咨询了家庭医生。
肌酐 0.7mg/dL，血糖 95mg/dL，Na+141mEq/L，K+3.9mEq/L，TSH 3.8mcUI/L（0.38-5.33），FT4 0.9ng/dL（0.6-1.1），皮质醇 215.4nmol/L（185-624），ACTH 21.9pg/mL（6-48），FSH 4.76UI/L，LH5.62UI/L，雌二醇 323pmol/L，IGF1 74.8ng/mL（88-209），PRL 24.7mcg/L（3.3-26.7），渗透压 298.2mOs/kg（250-325）；尿分析：尿量 10200mL/24h，渗透压 75mOs/kg（300-900），密度 1.002。在水限制试验中：0' - 血清渗透压 308.8mOsm/kg 与尿渗透压 61.0mOsm/kg 相比；60' - 尿渗透压 102mOsm/kg；去氨加压素后 1 小时尿渗透压为 511mOsm/kg。MRI 显示除 T1 加权成像上后叶垂体亮点缺失外，无符合垂体炎的异常征象。假设为 CDI，并开始用去氨加压素治疗。向国家卫生当局报告了潜在的不良反应。
在垂体炎的 MRI 中，T1 加权成像通常显示后叶垂体亮点缺失、垂体增大或柄增粗，但这些发现均不存在于该患者中。据我们所知，COVID-19 疫苗接种后从未报告过 CDI。
