Pituitary apoplexy in the aftermath of a SARS-CoV-2 infection: a case series from Amiens University Hospital

Abstract

Objective: Since the outbreak of the COVID-19 pandemic, several cases of pituitary apoplexy (PA) following a SARS-CoV-2 infection have been described in several countries. Here, we describe a case series of PA occurring in the aftermath of a SARS-CoV-2 infection to alert physicians about possible neuro-endocrinological damage caused by the virus that can lead to visual sequelae and hypopituitarism. Design and Methods: We retrospectively identified all the adult patients treated at Amiens University Hospital between March 2020 and May 2021 for PA confirmed by cerebral imaging and following an RT-PCR-confirmed SARS-CoV-2 infection. Results: Eight cases (6 women, 2 men) occurred between March 2020 and May 2021 and were reviewed in this study. The mean age at diagnosis was 67.5 ± 9.8 years. Only one patient had a 'known' non-functional pituitary macroadenoma. The most common symptom of PA was a sudden headache. Brain imaging was typical in all cases. Only two patients required decompression surgery, whereas the others were managed conservatively. The clinical outcome was favorable for all patients but without recovery of their pituitary deficiencies. There was no diabetes insipidus. Conclusion: This case series, the largest in the literature, reinforces the strength, consistency, and coherence of the association between SARS-CoV-2 infection and PA. Our study provides support for the hypothesis that SARS-CoV-2 may be a new precipitating factor for PA. It is essential that practitioners be alerted about possible pituitary disease due to the virus so that such patients are recognized and appropriately managed, hence improving their prognosis.

Pituitary apoplexy in SARS-CoV-2 infected is not necessarily related to the virus

“…The latency between SARS-CoV-2 infection and onset of pituitary apoplexy was fairly long in four patients (1). The latency was 16 weeks in patient 2, 12 weeks in patient 6, 8 weeks in patient 1, and 7 weeks in patient 8 (1).…”

“…The latency between recognition of the SARS-CoV-2 infection was 0-16 weeks, two had compression of the optic chiasm, seven each required hydrocortisone or l-thyroxin, and one decompressive surgery (1). Four had visual impairment, which resolved only partially in three (1). The outcome of the headache was only insufficiently documented.…”

“…We read with interest the article by Balmain et al about eight patients in whom pituitary apoplexy was attributed to previous or concomitant SARS-CoV-2 infection (1). The latency between recognition of the SARS-CoV-2 infection was 0-16 weeks, two had compression of the optic chiasm, seven each required hydrocortisone or l-thyroxin, and one decompressive surgery (1).…”

Spot the adenoma after pituitary apoplexy following a SARS-CoV-2 vaccination

“…Although pituitary apoplexy has been repeatedly reported in patients with SARS-CoV-2 infection [3] , it has been only rarely reported as a complication of anti-SARS-CoV-2 vaccinations (table 1) 1 , 4 , 5 , 6 , 7 . This circumstance could indicate that there is no causal relation between anti-SARS-CoV-2 vaccination and pituitary apoplexy or that pituitary apoplexy is truly an extremely rare side effect of the vaccination.…”

“…Missing is the information if the index patient was truly SARS-CoV-2 negative. Because pituitary apoplexy occurs much more commonly in association with a SARS-CoV-2 infection than a vaccination [3] and because anti-SARS-CoV-2 vaccination does not rule a SARS-CoV-2 infection, it is crucial to know the results of the PCR test.…”