Coronavirus as a trigger of lymphocytic hypophysitis in an adolescent girl: An exceptional case report

Zerrouki, Dounia; Assarrar, Imane; Rami, Imane; Rouf, Siham; Latrech, Hanane

doi:10.1016/j.ijscr.2023.109218

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…Histopathological examination confirmed the lesion as LYH ( Figures 2J – M ). Combining with literature reports ( 20 – 23 ), there is no relevant documentation on the combination of Hypophysitis and cyst. Unfortunately, we did not conduct pathological examination on the cystic fluid, and thus, cannot rule out whether it is a combination of Hypophysitis and Rathke’s cyst.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal transsphenoidal surgery for unusual sellar lesions: eight cases and review of the literature

Wu,

Deng,

Qian

et al. 2024

Front. Neurol.

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BackgroundPreoperative imaging for some unusual lesions in the sellar region can pose challenges in establishing a definitive diagnosis, impacting treatment strategies.MethodsThis study is a retrospective analysis of eight cases involving unusual sellar region lesions, all treated with endoscopic endonasal transsphenoidal surgery (EETS). We present the clinical, endocrine, and radiological characteristics, along with the outcomes of these cases.ResultsAmong the eight cases, the lesions were identified as follows: Solitary fibrous tumor (SFT) in one case, Lymphocytic hypophysitis (LYH) in one case, Cavernous sinus hemangiomas (CSH) in one case, Ossifying fibroma (OF) in two cases; Sphenoid sinus mucocele (SSM) in one case, Pituitary abscess (PA) in two cases. All patients underwent successful EETS, and their diagnoses were confirmed through pathological examination. Postoperatively, all patients had uneventful recoveries without occurrences of diabetes insipidus or visual impairment.ConclusionOur study retrospectively analyzed eight unusual lesions of the sellar region. Some lesions exhibit specific imaging characteristics and clinical details that can aid in preoperative diagnosis and inform treatment strategies for these unusual sellar diseases.

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Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal transsphenoidal surgery for unusual sellar lesions: eight cases and review of the literature

Wu,

Deng,

Qian

et al. 2024

Front. Neurol.

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“…( 27 ) observed reduced immunostaining of corticotropic, somatotropic, and thyrotropic cells in SARS-CoV-infected patients. In addition, given the high genetic similarity between SARS-CoV and SARS-CoV-2, adenohypophysitis has also been observed during the acute phase of COVID-19, with secondary adrenal insufficiency being higher in patients with long COVID (LC) ( 20 , 28 – 35 ).…”

Section: Hypopituitarism In the Long Covidmentioning

confidence: 99%

“…On the other hand, evidence suggests that a short course of corticosteroids at the onset of the disease may be beneficial in patients with autoimmune hypophysitis after viral infections or vaccinations and may improve the associated immunological alterations ( 20 , 26 , 35 , 74 , 79 , 242 – 244 ). It is believed that corticoids-mediated inhibition of ACTH secretion reduces the production of anti-ACHT antibodies, which in turn allows an increase in the anti-viral humoral response against the viral antigen with molecular mimicry with human ACTH ( 42 ).…”

Section: Treatmentmentioning

confidence: 99%

“…In addition, the use of antivirals could also decrease T-cell exhaustion by decreasing chronic exposure to viral antigens. If the infection and inflammation resolve after treatment and the pituitary parenchyma is not destroyed, remission could occur ( 35 , 245 , 246 ). However, it is crucial to keep in mind that if, at the end of corticosteroid and antiviral treatment, symptoms reappear with a decrease in ACTH levels, this could indicate potentially permanent pituitary damage (pituitary atrophy) ( 78 , 245 , 246 ).…”

Section: Treatmentmentioning

confidence: 99%

“…Treatment may be useful in classic cases of ASIA syndrome or non-latent infections with little pituitary damage, where corticosteroids can be used temporarily until complete elimination of the adjuvant or virus ( 35 , 243 , 244 , 246 – 248 ). However, complications arise when the damage is permanent, treated late, or when the adjuvant (e.g., vaccines) or latent viral infection (e.g., herpesvirus) chronically persists in the body, directly (persistence of ACTH-mimetic viral antigen) or indirectly affecting the HPA axis (via proinflammatory cytokines) ( 10 , 67 , 76 , 246 , 249 ).…”

Section: Treatmentmentioning

confidence: 99%

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Hypocortisolemic ASIA: a vaccine- and chronic infection-induced syndrome behind the origin of long COVID and myalgic encephalomyelitis

Ruiz-Pablos,

Paiva,

Zabaleta

2024

Front. Immunol.

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Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), long COVID (LC) and post-COVID-19 vaccine syndrome show similarities in their pathophysiology and clinical manifestations. These disorders are related to viral or adjuvant persistence, immunological alterations, autoimmune diseases and hormonal imbalances. A developmental model is postulated that involves the interaction between immune hyperactivation, autoimmune hypophysitis or pituitary hypophysitis, and immune depletion. This process might begin with a deficient CD4 T-cell response to viral infections in genetically predisposed individuals (HLA-DRB1), followed by an uncontrolled immune response with CD8 T-cell hyperactivation and elevated antibody production, some of which may be directed against autoantigens, which can trigger autoimmune hypophysitis or direct damage to the pituitary, resulting in decreased production of pituitary hormones, such as ACTH. As the disease progresses, prolonged exposure to viral antigens can lead to exhaustion of the immune system, exacerbating symptoms and pathology. It is suggested that these disorders could be included in the autoimmune/adjuvant-induced inflammatory syndrome (ASIA) because of their similar clinical manifestations and possible relationship to genetic factors, such as polymorphisms in the HLA-DRB1 gene. In addition, it is proposed that treatment with antivirals, corticosteroids/ginseng, antioxidants, and metabolic precursors could improve symptoms by modulating the immune response, pituitary function, inflammation and oxidative stress. Therefore, the purpose of this review is to suggest a possible autoimmune origin against the adenohypophysis and a possible improvement of symptoms after treatment with corticosteroid replacement therapy.

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Hypophysitis in COVID-19: a systematic review

Menotti,

di Filippo,

Terenzi

et al. 2024

Pituitary

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Coronavirus as a trigger of lymphocytic hypophysitis in an adolescent girl: An exceptional case report

Cited by 5 publications

References 22 publications

Endoscopic endonasal transsphenoidal surgery for unusual sellar lesions: eight cases and review of the literature

Endoscopic endonasal transsphenoidal surgery for unusual sellar lesions: eight cases and review of the literature

Hypocortisolemic ASIA: a vaccine- and chronic infection-induced syndrome behind the origin of long COVID and myalgic encephalomyelitis

Hypophysitis in COVID-19: a systematic review

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