key: cord-0906192-scp5v9h2
authors: Roncati, Luca; Manenti, Antonio
title: Pituitary apoplexy following adenoviral vector-based COVID-19 vaccination
date: 2022-04-19
journal: Brain Hemorrhages
DOI: 10.1016/j.hest.2022.04.002
sha: e24b8a337b04d6a32b9e8b1e3d12445d4681afac
doc_id: 906192
cord_uid: scp5v9h2

Pituitary apoplexy (PA) may complicate the course of coronavirus disease 2019 (COVID-19), posing a potential threat to life. Among vaccines designed to prevent COVID-19, there are those adenoviral vector-based, such as Vaxzevria® (formerly COVID-19 Vaccine AstraZeneca). The product insert states that it can cause very rare coagulation disorders, in particular thrombosis with thrombocytopenia syndrome in some cases accompanied by bleeding, cerebrovascular venous or sinus thrombosis, and thrombocytopenia, including immune thrombocytopenia, also associated with bleeding. Here, we report the onset of PA after Vaxzevria® in a 28-year-old healthy Caucasian female, who experienced long-lasting tension-type headache, hyperprolactinemia and menstrual changes, without thrombocytopenia or thrombosis.

Pituitary apoplexy (PA) has been recently described as a possible complication of coronavirus disease 2019 (COVID-19). 1,2 PA represents a potentially life-threatening condition due to impaired blood supply of the pituitary gland from either hemorrhage or infarction. 1 Both bleeding and thrombotic events have been reported following Vaxzevria® (formerly COVID-19 Vaccine AstraZeneca), even in unusual sites such as cerebral venous sinuses, with or without thrombocytopenia. 3 A 28-year-old healthy Caucasian female suffered of 38°C fever for 24 hours and tension-type headache for a full month after the first dose of Vaxzevria®. The post-vaccinal laboratory tests did not reveal thrombocythemia (platelets: 239.00 x10 3 /µL), neither thrombosis (D-dimer: < 270.00 ηg/mL). At a time distance of two months from the first inoculation, the patient underwent the second dose, and headache came back even more intense without fever or visual changes. Because of the persistence of headache accompanied by amenorrhea and hyperprolactinemia (Table 1) , most likely from prolactin-inhibiting factor impairment, the patient was submitted to magnetic resonance imaging (MRI) without contrast 69 days after the second dose: a signal alteration possibly related to a hemorrhagic event was detected in the right half of the sella turcica (Fig. 1A) . The gadolinium contrast-enhanced MRI performed 35 days later confirmed the PA presence (Fig. 1B) ; the control MRI at a time distance of 101 days showed an improving picture, in conjunction with menstrual recovery. The present case is quite similar to that reported by Piñar-Gutiérrez et al., 4 

PATIENT RESULTS NORMAL RANGES 

Coronavirus disease 2019 and pituitary apoplexy: a single-center case series and review of the literature

COVID-19 and the pituitary

Vaxzevria (previously COVID-19 Vaccine AstraZeneca): EPAR -product information. Annex I -summary of product characteristics

Case report: pituitary apoplexy after COVID-19 vaccination

Menstruation and Covid-19 vaccination

Vaccine-induced immune thrombotic thrombocytopenia (VITT): update on diagnosis and management considering different resources

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. 

Informed consent was obtained from the patient for publication of the anonymized details concerning with her medical case and any accompanying images.

The authors declare no competing interest.

All relevant data generated or analyzed during this research were included in the article; further enquiries can be directed to the corresponding author upon reasonable request.

LR: study concept and design, drafting of the manuscript, and study supervision. AM: interpretation of imaging data, and critical revision. All authors approved the final version of the manuscript.