Department of Metabolism, Endocrinology and Molecular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan.
Department of Vascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan.
Endocr J. 2024 Dec 2;71(12):1165-1173. doi: 10.1507/endocrj.EJ24-0093. Epub 2024 Aug 27.
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, and various complications have been reported. Furthermore, there have been increasing reports of endocrinopathy related to COVID-19 following the pandemic. We report a 49-year-old healthy woman who developed rapid onset of polydipsia and polyuria three weeks after COVID-19. Laboratory tests indicated low urine osmolarity and increased serum osmolarity, and antidiuretic hormone (ADH) was undetectable. Urine osmolality remained low with water deprivation. Similarly, plasma ADH responses to hypertonic-saline infusion were blunted and urine osmolality increased in response to desmopressin. There was no clear evidence of anterior pituitary dysfunction. T1-weighted magnetic resonance imaging (MRI) showed pituitary stalk thickening and absence of posterior pituitary bright signal spots, suggesting the presence of hypophysitis. Based on these results, we made a probable diagnosis of lymphocytic infundibulo-neurohypophysitis (LINH) which have caused central diabetes insipidus. Positive findings for serum anti-rabphilin-3A antibodies, reported as a potential diagnostic marker for LINH, were also noted. Following oral desmopressin administration, polydipsia and polyuria were quickly improved, though treatment with desmopressin was still required over four months. This is the first report of a patient with a probable diagnosis of LINH after COVID-19 who tested positive for anti-rabphilin-3A antibodies. Positive findings for those antibodies suggest that pituitary dysfunction associated with COVID-19 is hypophysitis involving an abnormal immune mechanism. The presence of anti-rabphilin-3A antibodies may be useful as a non-invasive diagnostic marker of LINH and potentially serve as a valuable diagnostic aid in cases of LINH associated with COVID-19.
新型冠状病毒病（COVID-19）是由严重急性呼吸系统综合征冠状病毒 2 引起的，已报告多种并发症。此外，随着大流行的发生，与 COVID-19 相关的内分泌疾病的报道也越来越多。我们报告了一例 49 岁健康女性，她在 COVID-19 后三周出现快速发作的多饮和多尿。实验室检查表明尿渗透压低，血清渗透压高，抗利尿激素（ADH）不可检测。禁水后尿渗透压仍低。同样，高渗盐水输注引起的血浆 ADH 反应减弱，而去氨加压素引起尿渗透压增加。没有明显的垂体前叶功能障碍证据。T1 加权磁共振成像（MRI）显示垂体柄增粗，后叶垂体亮点信号缺失，提示存在垂体炎。根据这些结果，我们做出了淋巴细胞性漏斗神经垂体炎（LINH）的可能诊断，导致中枢性尿崩症。还注意到血清抗 rabphilin-3A 抗体的阳性发现，该抗体被报道为 LINH 的潜在诊断标志物。口服去氨加压素后，多饮和多尿迅速改善，但仍需要四个多月的去氨加压素治疗。这是首例 COVID-19 后可能诊断为 LINH 并检测出抗 rabphilin-3A 抗体阳性的患者报告。这些抗体的阳性发现表明，与 COVID-19 相关的垂体功能障碍是涉及异常免疫机制的垂体炎。抗 rabphilin-3A 抗体的存在可能作为 LINH 的非侵入性诊断标志物有用，并可能作为 COVID-19 相关 LINH 的有价值的诊断辅助手段。
