Pituitary apoplexy following adenoviral vector-based COVID-19 vaccination

Abstract

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.

Keywords: COVID-19 Vaccine AstraZeneca; COVID-19, Coronavirus disease 2019; Coronavirus disease 2019 (COVID-19); MRI, Magnetic resonance imaging; Magnetic resonance imaging (MRI); Menstrual changes; PA, Pituitary apoplexy; Pituitary apoplexy; VITT, Vaccine-induced immune thrombotic thrombocytopenia; Vaxzevria®.

Fig. 1

MRI images proving PA and excluding lesions in the cortex, cerebellum, brain stem, pituitary stalk, and posterior lobe. A) Unenhanced T2-weighted coronal section performed 69 days after the second vaccination dose: in the right part of the anterior hypophysis lobe, an oval area about 10x5 mm in size is well noticeable (arrow). B) Enhanced T2-weighted sagittal section performed 35 days later: the same area is not contrast-enhanced (arrow) and corresponds to a small convexity in the superior rim of the pituitary capsule, while the hypophysis stalk and posterior lobe show an early and marked contrast enhancement.