Ragni Alberto, Biamonte Emilia, Cavigiolo Beatrice, Mollero Edoardo Luigi Maria, Bendotti Giulia, Gabellieri Enrico, Leporati Paola, Gallo Marco
Endocrinology and Metabolic Diseases Unit, SS. Antonio e Biagio e Cesare Arrigo Teaching Hospital, Alessandria, Italy.
Endocrinology Unit, Maggiore della Carità Teaching Hospital, University of Eastern Piedmont, Novara, Italy.
Endocrine. 2025 Feb;87(2):459-467. doi: 10.1007/s12020-024-04078-7. Epub 2024 Oct 21.
Pituitary apoplexy (PA) has been increasingly reported in association with both infection from and vaccination for COVID19. Our aim was to analyse the available published cases and compare the clinical characteristics in the two groups (infection vs vaccination).
We systematically reviewed the published literature for all cases of PA associated with COVID19 infection or vaccination. We also presented two cases managed at our Centre.
Collectively, fortythree cases were analysed. Patients with PA after COVID19 vaccination (n = 7), compared with patients with PA after COVID19 infection (n = 36), were significantly younger (p = 0.009) and had a more abrupt onset of PA (p = 0.022), but showed a milder hormonal involvement (p = 0.008) and a lower rate of persistent hypopituitarism during follow-up (p = 0.001). Patients in the vaccination group did not have clinical risk factors for PA, although this difference did not reach statistical significance.
PA associated with COVID19 is a rare but clinically significant entity, although pathophysiological details of this association are lacking. Given the significantly different clinical presentation, we could speculate that PA induced by COVID19 vaccination might represent a distinct clinical entity, with different pathophysiological mechanism, compared to PA from COVID19 infection.
垂体卒中（PA）与新冠病毒感染及新冠疫苗接种相关的报道日益增多。我们的目的是分析已发表的相关病例，并比较两组（感染组与疫苗接种组）的临床特征。
我们系统回顾了已发表的所有与新冠病毒感染或疫苗接种相关的PA病例文献。我们还介绍了在我们中心治疗的两例病例。
共分析了43例病例。与新冠病毒感染后发生PA的患者（n = 36）相比，新冠疫苗接种后发生PA的患者（n = 7）明显更年轻（p = 0.009），PA发病更急（p = 0.022），但激素受累较轻（p = 0.008），随访期间持续性垂体功能减退的发生率较低（p = 0.001）。疫苗接种组患者没有PA的临床危险因素，尽管这种差异未达到统计学意义。
与新冠病毒相关的PA是一种罕见但具有临床意义的病症，尽管缺乏这种关联的病理生理细节。鉴于临床表现存在显著差异，我们可以推测，与新冠病毒感染引起的PA相比，新冠疫苗接种诱发的PA可能代表一种具有不同病理生理机制的独特临床实体。
