Isolated ACTH deficiency following immunization with the BNT162b2 SARS-CoV-2 vaccine: a case report.
BMC Endocr Disord
; 22(1): 185, 2022 Jul 19.
Article
in English
| MEDLINE | ID: covidwho-1938308
ABSTRACT
BACKGROUND:
The global COVID-19 pandemic requires urgent development of new vaccines. Endocrinological adverse effects following the new mRNA vaccine against COVID-19 have been reported in several cases. Specific to the involvement of pituitary function; however, only a single case with hypophysis has been reported. This is the first case of isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) following mRNA vaccination against COVID-19. CASE PRESENTATION A healthy 31-year-old man received the BNT162b2 SARS-CoV-2 mRNA vaccine. The first injection was uneventful. One day after the second injection, he noticed general fatigue and fever. In the following several days, he additionally developed headaches, nausea, and diarrhea. Four days after the vaccine injection, he visited a hospital with worsening of these symptoms. Physical examination revealed slight disorientation but no other deficits. Laboratory tests revealed hyponatremia, hypoglycemia, and extremely low plasma ACTH and serum cortisol levels (ACTH < 1.5 pg/ml, cortisol 1.6 µg/dl). He was diagnosed with adrenal crisis and was emergently treated with hydrocortisone. The symptoms responded well and he recovered within a few days. Magnetic resonance images after the replacement with hydrocortisone revealed an atrophic pituitary gland. The patient was referred to our tertiary hospital for further endocrinological examination. Pituitary endocrine load tests revealed isolated adrenocortical response deficiency. After other clinical assessments, he was diagnosed as having isolated ACTH deficiency. After initiation of hydrocortisone replacement, there has been no recurrence of symptoms related to adrenocortical insufficiency nor involvement of other pituitary functions.CONCLUSION:
This is the first reported case of IAD potentially associated with COVID-19 immunization. Recent reports have emphasized the importance of adjuvants in the mRNA vaccine that induce the endocrinological adverse effects through disturbance of the autoimmune system, but details are still unclear. Given the broad and rapid spread of vaccinations against COVID-19, it is clinically important to consider that there could be cases with a rare but emergent adrenal crisis even among those who present common symptoms of adverse effects following inactive SARS-CoV-2 mRNA vaccination.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Adrenal Insufficiency
/
Adrenocorticotropic Hormone
/
Endocrine System Diseases
/
COVID-19
/
BNT162 Vaccine
/
Hypoglycemia
Type of study:
Case report
/
Observational study
/
Prognostic study
Topics:
Vaccines
Limits:
Adult
/
Humans
/
Male
Language:
English
Journal:
BMC Endocr Disord
Year:
2022
Document Type:
Article
Affiliation country:
S12902-022-01095-3
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