[Hypophysitis and reversible hypopituitarism developed after COVID-19 infection - a clinical case report].

Q4 Medicine Problemy endokrinologii Pub Date : 2022-03-24 DOI:10.14341/probl12896
N Yu Gorbova, V P Vladimirova, L Y Rozhinskaya, Zh Y Belaya
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引用次数: 3

Abstract

Aim: To present a clinical case of reversible hypopituitarism due to hypophysitis developed after COVID-19 infection.

Materials and methods: A patient with residual clinical manifestations of hypopituitarism underwent clinical evaluation at the time of symptoms of hypopituitarism and in follow-up. Morning serum cortisol (171-536 nmol/l) was measured by electrochemiluminescence immunoassay. Morning ACTH (7.2-63.3 pg/ml), prolactin (66-436 mU/l), TSH (0.25-3.5 mIU/L), fT4 (9-19 pmol/l) and fT3 (2.6-5.7 pmol/l) were measured by chemiluminescence immunoassay. Data were analyzed throughout the course of the disease.

Results: A 35-year-old female developed clinical symptoms of hypopituitarism two months after recovery from a confirmed COVID-19 infection. Laboratory investigation confirmed hypocorticism, hypothyroidism, hypogonadism and the patient was prescribed appropriate hormonal therapy in January 2021. Four months later the symptoms were alleviated (April 2021) and there were signs of recovery shown by imaging and hormonal: morning serum cortisol 227 nmol/l, morning ACTH 33.96 pg/ml, prolactin 68.3 mU/l, TSH 2.626 mIU/L, fT4 10.75 pmol/l, fT3 3.96 pmol/l. Thyroid hormone was discontinued, but hypogonadism and hypocorticism persisted with estradiol - 51.48 pmol/l, 24h urine cortisol level - 41.8 nmol/day. MRI results showed that the signs of hypophysitis were alleviated in comparison with MRI from January 2021. Full recovery of pituitary axis was reported in October 2021, with recovery of normal menstrual cycle. Furthermore, hormonal profile was likewise normal.

Conclusion: This report provides evidence of delayed damage to the pituitary gland after infection with the COVID-19, with recovery of its function and structure. To date, the mechanisms of such an impact are not entirely clear; further collection of data on such cases and analysis is required.

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【新冠肺炎感染后并发垂体炎和可逆性垂体功能减退1例临床报告】。
目的:报道1例新型冠状病毒感染后并发垂体炎导致可逆性垂体功能减退的临床病例。材料与方法:对1例垂体功能减退残余临床表现患者在出现垂体功能减退症状时及随访时进行临床评价。电化学发光免疫法测定晨间血清皮质醇(171 ~ 536 nmol/l)。化学发光免疫法测定晨间ACTH (7.2 ~ 63.3 pg/ml)、催乳素(66 ~ 436 mU/l)、TSH (0.25 ~ 3.5 mIU/ l)、fT4 (9 ~ 19 pmol/l)、fT3 (2.6 ~ 5.7 pmol/l)。在整个病程中对数据进行分析。结果:一名35岁的女性在确诊感染COVID-19后康复两个月后出现垂体功能减退的临床症状。实验室检查证实患者皮质功能减退、甲状腺功能减退、性腺功能减退,并于2021年1月给予适当的激素治疗。4个月后(2021年4月)症状缓解,影像学及激素指标显示恢复迹象:晨间血清皮质醇227 nmol/l,晨间ACTH 33.96 pg/ml,催乳素68.3 mU/l, TSH 2.626 mIU/ l, fT4 10.75 pmol/l, fT3 3.96 pmol/l。停用甲状腺激素,但性腺功能减退和皮质功能减退持续存在,雌二醇为51.48 pmol/l, 24h尿皮质醇水平为41.8 nmol/d。MRI结果显示,与2021年1月MRI相比,垂体炎症状减轻。2021年10月垂体轴完全恢复,月经周期恢复正常。此外,激素水平也同样正常。结论:本报告提供了新冠病毒感染后脑垂体迟发性损伤的证据,其功能和结构得到恢复。迄今为止,这种影响的机制尚不完全清楚;需要进一步收集这类案件的数据并进行分析。
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来源期刊
Problemy endokrinologii
Problemy endokrinologii Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
1.40
自引率
0.00%
发文量
59
期刊介绍: Since 1955 the “Problems of Endocrinology” (or “Problemy Endocrinologii”) Journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of endocrinology. The Journal is aimed to the most topical issues of endocrinology: to chemical structure, biosynthesis and metabolism of hormones, the mechanism of their action at cellular and molecular level; pathogenesis and to clinic of the endocrine diseases, new methods of their diagnostics and treatment. The Journal: features original national and foreign research articles, reflecting world endocrinology development; issues thematic editions on specific areas; publishes chronicle of major international congress sessions and workshops on endocrinology, as well as state-of-the-art guidelines; is intended for scientists, endocrinologists diabetologists and specialists of allied trade, general practitioners, family physicians and pediatrics.
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