FRI329 COVID-19: An Uncommon Cause Of Hypophysitis
Authors: Medina-Torres Wilnelia , Ortiz-Rivera Monica Alexandra , Madera Marin Luis Norberto , Rosado-Burgos Alexandra , Sepulveda-Garcia Luis Ruben , Musa Penna Laurianne El , Ramirez Margarita , Gonzalez-Rodriguez Loida Alejandra , Alvarado Milliette , Feliciano-Emmanvel Melba 
Published: October 2023

Abstract
Disclosure: W. Medina-Torres: None. M.A. Ortiz-Rivera: None. L.N. Madera Marin: None. A. Rosado-Burgos: None. L.R. Sepulveda-Garcia: None. L. El Musa Penna: None. M. Ramirez: None. L.A. Gonzalez-Rodriguez: None. M. Alvarado: None. M. Feliciano-Emmanvel: None.
COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. One of the virus four structural proteins, the spike(S) protein, contains a region that binds to the extracellular domain of angiotensin-converting enzyme 2 (ACE2). The virus uses the S protein to enter the cell by binding to the ACE2 receptor. Literature has reported that ACE2 receptors are extensively expressed in numerous human tissues and organs, such as in the heart, lung, kidney, testis and brain. Despite it is demonstrated that lungs inflammation is one of the main symptoms during SARS-CoV-2 infection, the moderate expression of ACE2 among other organs may explain the involvement and subsequent impairments of various organs during and after the SARS-CoV-2 infection. Although ACE2 is expressed in several endocrine glands, including the pancreas, thyroid gland, ovaries and testes; pituitary gland expression is limited. Only few cases have been reported in the literature of direct damage to the pituitary gland post covid-19 infection. This is the case of a 31-year-old healthy athlete female without prior systemic illness who was taken to ER after developing hypotension and symptomatic hypoglycemia while flying from Barbados to Miami. Upon questioning, patient referred she was in her usual state of healthy athletic performance until 7 months ago when had mild symptomatic COVID-19. She was 4-months post-partum of a healthy baby and lactating normally, but after the 2-weeks isolation period since COVID-19 infection, she had no return of menstruation and unable to lactate. In addition, patient developed a depressive state, loss of appetite and progressive weight loss. Was found with low Blood pressure and initial laboratories showed pancytopenia and sustained hypoglycemia requiring uninterrupted D10 IV infusion. Laboratory work-up revealed both central adrenal insufficiency (ACTH &lt;1.5 pg/mL and serum cortisol 0.20 mcg/dL), secondary hypothyroidism (TSH: 2.8 mIU/L and free T4: 0.36 ng/dL). Contrast enhanced magnetic resonance imaging (MRI) of the brain was performed with evidence of prominent partial empty sella and slight nodular thickening of the pituitary stalk. Based on these findings a presumptive diagnosis of hypophysitis was made. Rapid clinical improvement was observed on corticosteroid replacement with resolution of hypoglycemia, hypotension, and anorexia, but diabetes insipidus was unmask. Additional laboratories revealed there was definitive panhypopituitarism, with evidence of hypogonadotropic hypogonadism, hypoprolactinemia and growth hormone deficiency. This case illustrates panhypopituitarism secondary to hypophysitis as an uncommon COVID-19 virus sequel. Thus, in patients with persistent non-specific symptoms post COVID-19 infection, it is important to have a high index of suspicious for endocrinopathies such as hypophysitis in order to provide prompt therapy and improve quality of life.
Presentation: Friday, June 16, 2023