Suspected Vaccine-Associated Hypophysitis With Central Diabetes Insipidus After AZD1222 SARS-CoV-2 Vaccination

A 69-year-old man presented for further investigation of polydipsia (liquid intake 6 L/day) and polyuria (micturition 1 ×/h). These symptoms had started around 2 weeks after his second AZD1222 vaccination. Endocrinological tests revealed central diabetes insipidus and mild prolactinemia, but no basal or dynamic abnormalities of the remaining hypophyseal hormone axes. The patient’s liquid intake, urinary volume, and serum sodium level returned to normal after the initiation of desmopressin treatment. Cranial magnetic resonance imaging showed the typical findings of hypophysitis, which is mostly caused by lymphocytic infiltration of the hypophysis. The differential diagnoses are hypophyseal adenoma or another form of hypophyseal tumor. An exhaustive diagnostic work-up revealed no signs of a drug-induced, infectious, parainfectious, or autoimmune reason for the hypophysitis. Although the cause of hypophysitis often remains unestablished, the short time between vaccination and onset prompts suspicion of an association. Further cases of hypophysitis with onset 1–2 weeks after SARS-CoV-2 infection or vaccination (mRNA and vector vaccines) have recently been described.

Figure

Cranial magnetic resonance imaging

Acknowledgment
We thank Dr. Georg Bohner of the Institute for Neuroradiology at Charité–University Medical Center Berlin for his support in interpreting the radiological findings..

Dr. med. Dominik Soll, Dr. med. Rebecca Heinz, Prof. Dr. med. Knut Mai
Charité-Universitätsmedizin Berlin, Medizinische Klinik mit S. Endokrinologie und Stoffwechsel einschließlich AB Lipidstoffwechsel, [e-mail].

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Soll D, Heinz R, Mai K: Suspected vaccine-associated hypophysitis with central diabetes insipidus after AZD1222 SARS-CoV-2 vaccination. Dtsch Arztebl Int 2024; 121: 414. DOI: 10.3238/arztebl.m2023.0106