PDF(Pubmed)
Abstract：
BACKGROUND: Arginine vasopressin deficiency (AVP-D) can occur due to various conditions, so clarifying its cause is important for deciding treatment strategy. Although several cases of AVP-D following coronavirus disease 2019(COVID-19) infection or COVID-19 vaccination have been reported, the diagnosis of the underlying disease has not been reported in most cases.
METHODS: A 75-year-old woman who presented with polydipsia and polyuria 9 weeks after contracting COVID-19 and 5 weeks after receiving the SARS-CoV-2 vaccination, leading to the final diagnosis of AVP-D 8 months after the first appearance of symptoms. Interestingly, pituitary magnetic resonance imaging (MRI) still revealed stalk enlargement frequently observed in patients with SARS-CoV-2 vaccination-induced AVP-D. Although this finding could not rule out any malignancies, we additionally measured anti-rabphilin-3A antibodies, a known marker for lymphocytic infundibulo-neurohypophysitis (LINH), and found that the results were positive, strongly suggesting LINH as the cause of this disease. Thus, we avoided pituitary biopsy. At the follow-up MRI conducted 12 months after the initial consultation, enlargement of the pituitary stalk was still observed.
CONCLUSIONS: We experienced a case with LINH probably induced by SARS-CoV-2 vaccination. In SARS-CoV-2 vaccination-related LINH, unlike typical LINH, there is a possibility of persistent pituitary stalk enlargement on MRI images for an extended period, posing challenges in differential diagnosis from other conditions. Pituitary stalk enlargement and positive anti-rabphilin-3A antibodies may help in the diagnosis of AVP-D induced by SARS-CoV-2 vaccination.
METHODS: A 75-year-old woman who presented with polydipsia and polyuria 9 weeks after contracting COVID-19 and 5 weeks after receiving the SARS-CoV-2 vaccination, leading to the final diagnosis of AVP-D 8 months after the first appearance of symptoms. Interestingly, pituitary magnetic resonance imaging (MRI) still revealed stalk enlargement frequently observed in patients with SARS-CoV-2 vaccination-induced AVP-D. Although this finding could not rule out any malignancies, we additionally measured anti-rabphilin-3A antibodies, a known marker for lymphocytic infundibulo-neurohypophysitis (LINH), and found that the results were positive, strongly suggesting LINH as the cause of this disease. Thus, we avoided pituitary biopsy. At the follow-up MRI conducted 12 months after the initial consultation, enlargement of the pituitary stalk was still observed.
CONCLUSIONS: We experienced a case with LINH probably induced by SARS-CoV-2 vaccination. In SARS-CoV-2 vaccination-related LINH, unlike typical LINH, there is a possibility of persistent pituitary stalk enlargement on MRI images for an extended period, posing challenges in differential diagnosis from other conditions. Pituitary stalk enlargement and positive anti-rabphilin-3A antibodies may help in the diagnosis of AVP-D induced by SARS-CoV-2 vaccination.
摘要：
背景：精氨酸加压素缺乏症（AVP-D）可能由于各种情况而发生，因此，澄清其原因对于决定治疗策略很重要。尽管已经报告了几例2019年冠状病毒病（COVID-19）感染或COVID-19疫苗接种后的AVP-D病例，在大多数情况下，尚未报告潜在疾病的诊断。
方法：一名75岁女性，在感染COVID-19后9周和接受SARS-CoV-2疫苗接种后5周出现多饮和多尿，导致在首次出现症状后8个月最终诊断为AVP-D。有趣的是,垂体磁共振成像（MRI）仍显示在SARS-CoV-2疫苗接种诱导的AVP-D患者中经常观察到茎扩大。尽管这一发现不能排除任何恶性肿瘤，我们还检测了抗狂犬病蛋白-3A抗体，淋巴细胞漏斗-神经垂体炎（LINH）的已知标志物，发现结果是积极的，强烈暗示LINH是这种疾病的原因。因此，我们避免了垂体活检.在初次咨询后12个月进行的MRI随访中，仍观察到垂体柄增大。
结论：我们经历了一例可能由SARS-CoV-2疫苗引起的LINH病例。在SARS-CoV-2疫苗接种相关的LINH中，不像典型的LINH,在MRI图像上有可能持续的垂体柄增大，在与其他疾病的鉴别诊断中提出了挑战。垂体茎增大和抗狂犬病蛋白3A抗体阳性可能有助于诊断SARS-CoV-2疫苗诱导的AVP-D。
方法：一名75岁女性，在感染COVID-19后9周和接受SARS-CoV-2疫苗接种后5周出现多饮和多尿，导致在首次出现症状后8个月最终诊断为AVP-D。有趣的是,垂体磁共振成像（MRI）仍显示在SARS-CoV-2疫苗接种诱导的AVP-D患者中经常观察到茎扩大。尽管这一发现不能排除任何恶性肿瘤，我们还检测了抗狂犬病蛋白-3A抗体，淋巴细胞漏斗-神经垂体炎（LINH）的已知标志物，发现结果是积极的，强烈暗示LINH是这种疾病的原因。因此，我们避免了垂体活检.在初次咨询后12个月进行的MRI随访中，仍观察到垂体柄增大。
结论：我们经历了一例可能由SARS-CoV-2疫苗引起的LINH病例。在SARS-CoV-2疫苗接种相关的LINH中，不像典型的LINH,在MRI图像上有可能持续的垂体柄增大，在与其他疾病的鉴别诊断中提出了挑战。垂体茎增大和抗狂犬病蛋白3A抗体阳性可能有助于诊断SARS-CoV-2疫苗诱导的AVP-D。
