Abstract #1001394: A Rare Endocrine Complication of the COVID-19 Vaccine

Abstract

Pituitary adenomas are a common, asymptomatic finding in the general population. They are usually diagnosed incidentally on imaging studies. Rarely, pituitary adenomas can progress to pituitary apoplexy, defined as hemorrhage and/or infarction and are often associated with a triggering event. A 44 year old man with a history of hypogonadism presented to the hospital for fevers, chills and blurry vision that started after he received his second COVID-19 vaccine three days prior. The day following his vaccine, he initially developed subjective fevers, chills and myalgia which he self-treated with over the counter analgesics at home. Three days after the vaccine, he developed blurry vision along with change in mental status which brought him to the hospital. When he initially presented to an outside hospital, vital signs showed hypotension with MAP of 57 and fever of 103 degrees fahrenheit. MRI of the head showed a 4.7cm sellar and suprasellar mass with optic chiasm compression and left sphenoidal extension. Labs at the time showed FSH 10.5 IU/L, LH 3.3 IU/L, Prolactin 1.2 ng/mL, Cortisol 9.3 ug/dL at 5am, ACTH 7 pg/mL, TSH 2.90 uIU/mL, free T4 1.33 ng/dL and free T3 3.88 ng/dL. Due to the patient's hypotension and findings on imaging studies, there was concern for adrenal insufficiency and the patient was started on stress dose steroids. He was transferred to a tertiary care center and vitals at the time were significant for a temperature 105.9 degrees fahrenheit but otherwise hemodynamically stable. He underwent an endoscopic transsphenoidal resection of the pituitary tumor given compression of the optic chiasm. Pathology report was consistent with pituitary adenoma with focal hemorrhage and necrosis of pituitary adenoma cells. Patient currently remains on maintenance dose steroids and levothyroxine. Pituitary apoplexy can occur either spontaneously or due to a stressful trigger. There have been no case reports showing the novel COVID-19 vaccine leading to pituitary infarction or hemorrhage. Although the pathophysiology is not entirely clear, our patient may have developed a robust immune response that could have potentially been a trigger leading to a pituitary apoplexy.