Central Diabetes Insipidus Following Immunization With BNT162b2 mRNA COVID-19 Vaccine: A Case Report

Abstract

IntroductionCases 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.Case ReportWoman 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.Blood Analysiscreatinine 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.ConclusionIn 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.

Pituitary and SARS CoV-2: An unremitting conundrum

“…Not only SARS-CoV-2 itself but also specific vaccines against it could also potentially induce acute cytokine release [125] thus causing endocrine dysfunction [126] . Rare and isolated case reports raise the possibility of SIADH [127] , [128] or central AVP deficiency after vaccination- one case developing AVP deficiency one week after BNT162b2mRNA COVID-19 vaccine (BioNTech/Pfizer) administration, with infundibulo-neurohypophysitis on MRI images [129] .…”

Endocrine system after 2 years of COVID-19 vaccines: A narrative review of the literature

“…Finally, two more cases were reported, one concerning SIADH ( 60 ) occurred in a 79-year-old woman 10 days after the second dose of the Moderna mRNA-1273 and one regarding the onset of central diabetes insipidus ( 61 ) in a 37-year-old woman 7 days after the second dose of Pfizer/BioNtechBNT162b2 vaccine. In both cases, adequate treatment with desmopressin ( 61 ) or with intravenous crystalloid solutions, fluid restriction and oral urea ( 60 ) led to rapid improvement of the symptoms.…”

AVP deficiency (central diabetes insipidus) following immunization with anti-COVID-19 BNT162b2 Comirnaty vaccine in adolescents: A case report

“…recently collected and reviewed all published data on potential endocrine adverse effects post-COVID-19 vaccines in adult patients ( 6 ). Thyroid disorders are the most common; only eight cases of pituitary dysfunction have been described so far ( 10 – 12 , 21 – 25 ), of which two presented with CDI ( 11 , 12 ).…”