Central diabetes insipidus secondary to COVID-19 infection: a case report

Abstract

Background Novel coronavirus disease 2019 (COVID-19) mainly affects the lungs, but can involve several other organs. The diagnosis of acute and chronic sequelae is one of the challenges of COVID-19. The current literature proposes that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may involve the hypothalamic-pituitary axis. In this case report, we present a unique case of new-onset central diabetes insipidus secondary to the COVID-19 disease in a 54-year-old woman. Case presentation A 54-year-old woman presented with the history of excessive thirst, polyuria, and polydipsia, six weeks after being infected by COVID-19. Laboratory tests revealed low urine osmolarity and increased serum osmolarity, and the patient was diagnosed with central diabetes insipidus. After administration of nasal desmopressin, urinary osmolarity increased, and the patient's symptoms improved. However, to stabilize her condition, desmopressin treatment was required. Conclusions We reported a unique case of diabetes insipidus in a COVID-19 patient. Central diabetes insipidus may be included in clinical manifestations of the COVID-19, in case of new-onset polyuria and polydipsia following COVID-19 disease. Nevertheless, a causal relationship has not been established between the symptoms of the patient and the SARS-CoV-2 infection.

Pituitary and SARS CoV-2: An unremitting conundrum

“…It should be noted that new-onset arginine vasopressin (AVP) deficiency was also reported during or (more frequently) shortly after COVID-19 infection in several cases ( Table 1 ), raising the possibility of a causal relationship [45] , [46] , [47] , [48] , [49] , [50] . Possible putative mechanisms to explain AVP deficiency in this context are hypophysitis or immune-mediated, however the number of cases reported so far are too few to allow for any sound conclusion.…”

Diabetes Mellitus after COVID-19 infection in a healthcare worker

“…A rise in new-onset diabetes was found in several studies, particularly in patients with long-COVID [16,17]. SARS-CoV-2 infection might also lead to type 1 [18] or type 2 diabetes [17] or central diabetes insipidus [19] through complex and differing mechanisms. Glycemic parameters in patients with new-onset diabetes during the COVID-19 pandemic are otherwise more severe than in patients with new-onset diabetes before the pandemic [16,17].…”

Transient diabetes insipidus in critically ill COVID19 patients

“…The other descriptions are of a patient who was not treated with vasopressin [ 31 , 32 ]; a non-ECMO COVID-19 patient who developed central DI with brain edema [ 33 ]; and an ECMO patient who developed oliguria and hyponatremia while treated with vasopressin [ 34 ]. There are also three case reports of DI development as late sequala of mild to moderate COVID19 infection (4–8 weeks after COVID19 infection) [ [35] , [36] , [37] ]. Supplement 3 provides a more detailed literature review.…”