Verrienti Martina, Marino Picciola Valentino, Ambrosio Maria Rosaria, Zatelli Maria Chiara
Unit of Endocrinology and Metabolic Diseases, Department of Specialty Medicines, University Hospital of Ferrara, Ferrara, Italy.
Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44100, Italy.
Pituitary. 2024 Dec;27(6):970-985. doi: 10.1007/s11102-024-01402-2. Epub 2024 May 18.
This systematic review aims to examine the latest research findings and assess the impact of COVID-19 vaccination on the pituitary gland.
PubMed and Tripdatabase were searched from January 1st, 2020 to February 12th, 2024. Case reports, case series and reviews related to post COVID-19 vaccination pituitary disease were included. Eligible articles were tabulated and analysed in the attempt to provide an overview on the epidemiology, clinical presentation, imaging, treatment, outcomes and pathophysiological background of post COVID-19 vaccination pituitary disease.
Among the 23 case reports included in this review, post COVID-19 vaccination hypophysitis was reported in 9 patients, pituitary apoplexy (PA) in 6 cases, SIADH in 5 cases and Isolated ACTH deficiency in 2 cases. Additionally, precipitating adrenal crisis was registered in 7 patients and pituitary tumor enlargement in 1 patient after receiving COVID-19 vaccination.
Despite the rarity of these events, our research findings suggest an association between COVID-19 vaccination and the subsequent development of pituitary diseases. The most common manifestations include hypophysitis with ADH deficiency, PA and SIADH, with symptoms typically emerging shortly after vaccine administration. Potential pathogenetic mechanisms include molecular mimicry, vaccine adjuvants and vaccine-induced thrombotic thrombocytopenia (VITT), with the presence of ACE2 receptors in the hypothalamus-pituitary system contributing to the process. These findings can aid in diagnostic and treatment decisions for patients presenting with these syndromes. Nevertheless, given the rarity of these events, safety and efficacy of the currently available COVID-19 vaccines remain robust and we strongly advocate continuing pursuing vaccination efforts.
本系统评价旨在研究最新研究结果，并评估新冠病毒疫苗接种对垂体的影响。
检索2020年1月1日至2024年2月12日期间的PubMed和Trip数据库。纳入与新冠病毒疫苗接种后垂体疾病相关的病例报告、病例系列和综述。对符合条件的文章进行列表和分析，以概述新冠病毒疫苗接种后垂体疾病的流行病学、临床表现、影像学、治疗、结局和病理生理背景。
在本综述纳入的23例病例报告中，9例患者报告了新冠病毒疫苗接种后垂体炎，6例垂体卒中（PA），5例抗利尿激素分泌异常综合征（SIADH），2例孤立性促肾上腺皮质激素（ACTH）缺乏。此外，7例患者在接种新冠病毒疫苗后出现肾上腺危象，1例患者出现垂体瘤增大。
尽管这些事件罕见，但我们的研究结果表明新冠病毒疫苗接种与随后垂体疾病的发生之间存在关联。最常见的表现包括伴有抗利尿激素缺乏的垂体炎、PA和SIADH，症状通常在接种疫苗后不久出现。潜在的发病机制包括分子模拟、疫苗佐剂和疫苗诱导的血栓性血小板减少症（VITT），下丘脑-垂体系统中血管紧张素转换酶2（ACE2）受体的存在促成了这一过程。这些发现有助于对出现这些综合征的患者进行诊断和治疗决策。然而，鉴于这些事件的罕见性，目前可用的新冠病毒疫苗的安全性和有效性仍然很强，我们强烈主张继续推进疫苗接种工作。
