ReviewFrontiers in endocrinology2022
Pituitary apoplexy and COVID-19 vaccination: a case report and literature review.
Review in Frontiers in endocrinology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Pituitary and COVID-19 vaccination: a systematic review.Pituitary · 2024Pooled it
- Endocrine complications of COVID-19: diabetes, musculoskeletal, thyroid, pituitary, adrenal, and gonadal disorders.Journal of the Endocrine Society · 2026Review
- Clinical presentation and outcomes of pituitary apoplexy in patients with PitNETs: a real world Italian multicenter study.Journal of endocrinological investigation · 2026Article
- Endocrine disorders following SARS-CoV-2 vaccination: a comprehensive systematic review.Clinical and experimental vaccine research · 2026Article
- From HIV to SARS-CoV-2 associated neurological disorder ("HAND" to "SAND"): Viral infection as a "time-bomb" for the aging brain.Neuroscience applied · 2026Review
- Pituitary Apoplexy in a Child with Short Stature and Possible Recent SARS-CoV-2 Infection.Diagnostics (Basel, Switzerland) · 2025Article
- Hypophysitis after COVID-19 vaccination in a patient with Rathke's cleft cyst: A case report.Human vaccines & immunotherapeutics · 2024Article
- Pituitary Apoplexy: a re-appraisal of risk factors and best management strategies in the COVID-19 era.Pituitary · 2024Review
- Brain Arteriovenous Malformation Hemorrhage and Pituitary Adenoma in a COVID-19-Positive Patient.Cureus · 2024Article
- Review
- The Growing Understanding of the Pituitary Implication in the Pathogenesis of Long COVID-19 Syndrome: A Narrative Review.Advances in respiratory medicine · 2024Review
- Explaining Long COVID: A Pioneer Cross-Sectional Study Supporting the Endocrine Hypothesis.Journal of the Endocrine Society · 2024Article
- The mRNA-LNP vaccines - the good, the bad and the ugly?Frontiers in immunology · 2024Review
- Neurovascular Adverse Effects of Sars-Cov-2 Vaccination.Drug design, development and therapy · 2024Review
- COVID-19 mRNA Vaccines: Lessons Learned from the Registrational Trials and Global Vaccination Campaign.Cureus · 2024Review
- Transient Central Diabetes Insipidus (Arginine Vasopressin Deficiency) Following SARS-CoV-2 Vaccination: A Case Report and Literature Review.Endocrine, metabolic & immune disorders drug targets · 2024Review
- Article
- Neurological Adverse Reactions to SARS-CoV-2 Vaccines.Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology · 2023Review
- Article
- Pituitary apoplexy is not uncommon in pediatric patients and can be a manifestation of neuro-COVID.Annals of pediatric endocrinology & metabolism · 2023Article
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Authors and funding
11 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
A 50-year-old man was admitted to our hospital for vomit, nausea, diplopia, and headache resistant to analgesic drugs. Symptoms started the day after his third COVID-19 mRNA vaccine (Moderna) whereas SARS-CoV-2 nasal swab was negative. Pituitary MRI showed recent bleeding in macroadenoma, consistent with pituitary apoplexy. Adverse Drug Reaction was reported to AIFA (Italian Medicines Agency).A stress dexamethasone dose was administered due to the risk of adrenal insufficiency and to reduce oedema. Biochemistry showed secondary hypogonadism; inflammatory markers were elevated as well as white blood cells count, fibrinogen and D-dimer. Pituitary tumour transsphenoidal resection was performed and pathology report was consistent with pituitary adenoma with focal haemorrhage and necrosis; we found immunohistochemical evidence for SARS-CoV-2 proteins next to pituitary capillaries, in the presence of an evident lymphocyte infiltrate.Few cases of pituitary apoplexy after COVID-19 vaccination and infection have been reported. Several hypotheses have been suggested to explain this clinical picture, including cross-reactivity between SARS-CoV-2 and pituitary proteins, COVID-19-associated coagulopathy, infection-driven acutely increased pituitary blood demand, anti-Platelet Factor 4/heparin antibodies development after vaccine administration. Ours is the first case of SARS-CoV-2 evidence in pituitary tissue, suggesting that endothelial infection of pituitary capillaries could be present before vaccination, possibly due to a previous asymptomatic SARS-CoV-2 infection. Our case underlines that SARS-CoV-2 can associate with apoplexy by penetrating the central nervous system, even in cases of negative nasal swab. Patients with pituitary tumours may develop pituitary apoplexy after exposure to SARS-CoV-2, therefore clinicians should be aware of this risk.
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