Sex: F
Vaccine: COVID19
Symptoms: Weight, White blood cell count
Clinical narrative: hypophysitis with acute onset of diabetes insipidus, immediately after SARS-CoV-2 vaccination; hypophysitis with acute onset of diabetes insipidus, immediately after SARS-CoV-2 vaccination; This is a literature report for the following literature source(s):  A 48-year-old female patient received BNT162b2 (BNT162B2), on 27Jun2021 as dose 2, single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history included: "obesity" (ongoing). The patient's concomitant medications were not reported. Vaccination history included: BNT162b2 (DOSE 1), administration date: 21May2021, for COVID-19 immunisation, reaction(s): "Hypophysitis", "diabetes insipidus", "hypothyroidism", "Growth hormone deficiency", "Hypogonadism". The following information was reported: HYPOPHYSITIS (hospitalization), outcome "recovering", DIABETES INSIPIDUS (hospitalization, medically significant), outcome "recovered" and all described as "hypophysitis with acute onset of diabetes insipidus, immediately after SARS-CoV-2 vaccination". The event "hypophysitis with acute onset of diabetes insipidus, immediately after sars-cov-2 vaccination" required emergency room visit. The patient underwent the following laboratory tests and procedures: ACTH stimulation test (normal high range 47): 26 pg/mL, notes: showed appropriate response without adrenal insufficiency; Alanine aminotransferase (0-50): 29 IU/l; Angiotensin converting enzyme (9-67): 23 IU/l; Aspartate aminotransferase (0-45): 29 IU/l; Blood calcium (8.5-10.1): 9.6 mg/dl; Blood chloride (94-109): 108 mmol/L; Blood corticotrophin: 26 pg/mL, notes: Cosyntropin stimulation test during hospitalization at 0 min; Blood cortisol: 7.6 ug/dL, notes: Cosyntropin stimulation test during hospitalization at 0 min; 17.8 ug/dL, notes: Cosyntropin stimulation test during hospitalization at 30 min; 20.7 ug/dL, notes: Cosyntropin stimulation test during hospitalization at 60 min; Blood creatinine (0.52-1.04): 0.73 mg/dl; Blood follicle stimulating hormone (15.9-54): 5.2 IU/l; 5.3 IU/l; 5.4 IU/l; Blood glucose (70-99): 105 mg/dl; Blood immunoglobulin G (383-929): 569 mg/dl; Blood immunoglobulin G (242-700): 368 mg/dl; Blood immunoglobulin G (22-176): 73 mg/dl; Blood immunoglobulin G (4-86): 27 mg/dl; Blood luteinising hormone: 5.2 IU/l, notes: low; 2.6 IU/l; Blood luteinising hormone (23-116.3): 2.6 IU/l; 2.6 IU/l; 4.3 IU/l; Blood magnesium (1.6-2.3): 2.2 mg/dl; Blood osmolarity (275-295): 306 mmol/kg, notes: Before the test; 309 mmol/kg, notes: Water deprivation; 209 mmol/kg, notes: Desmopressin challenge; Blood phosphorus (2.5-4.5): 3.4 mg/dl; Blood potassium (3.4-5.3): 4.2 mmol/L; Blood pressure measurement: 122/84 mmHg; Blood prolactin (3-27): 23 ug/L, notes: within the normal range; 19 ug/L, notes: within the normal range; 15 ug/L, notes: within the normal range; Blood sodium (133-144): 142 mmol/L, notes: Before the test; 147 mmol/L, notes: Water deprivation; 139 mmol/L, notes: Desmopressin challenge; Blood thyroid stimulating hormone (0.4-4.00): 2.66, notes: Unit: mU/L After 1 month; 3.08, notes: Unit: mU/L, After 3 month; 2.48, notes: Unit: mU/L, After 5 month; Blood urea (7-30): 5 mg/dl; Body temperature: 98.6 Fahrenheit; Carbon dioxide (20-32): 30 mmol/L; Chest X-ray: Negative; C-reactive protein (0.0-8.0): 23.0 mg/l; Hematocrit (35.0-47.0): 45.40 %; Hemoglobin (11.7-15.7): 13.6 g/dl; Heart rate: 81, notes: Unit: /min; Human chorionic gonadotropin: Negative; Insulin-like growth factor (60-240): 66 ng/ml, notes: 1 month; 89 ng/ml, notes: 3 months; 125 ng/ml, notes: 5 months; Magnetic resonance imaging: show pituitary stalk thickening (yellow arrow) and, notes: and a partially empty sella (red arrow) 1 month after the 2nd vaccination; show unchanged pituitary stalk thickening, notes: (yellow arrow)and a partially empty sella (red arrow) 3 months after the 2nd vaccination; Metabolic function test: normal; Oestradiol: 307 pg/mL; Physical examination: unremarkable; Platelet count (150-450): 306 x10 3/mm3; Red blood cell sedimentation rate (0-20): 34, notes: Unit: mm/h; Serum ferritin (8-252): 14 ng/ml; Thyroxine (0.76-1.46): 0.88 ng/dL, notes: After 1 month; 0.88 ng/dL, notes: After 3 month; 0.96 ng/dL, notes: After 5 month; Urine analysis: 4 L, notes: daily urinary output was approximately; 2.2 L, notes: during 8 hours of stay in the emergency department; Urine osmolarity (100-1200): 97 mmol/kg, notes: Before the test; 83 mmol/kg, notes: Water deprivation; 468 mmol/kg, notes: Desmopressin challenge; Vital signs measurement: stable; Water deprivation test: showed hypernatremia, notes: since the first vaccination; Weight: weight loss of a total of 18 kg; White blood cell count (4.0-11.0): 8.3 x10 3/mm3. Therapeutic measures were taken as a result of hypophysitis, diabetes insipidus. When she received the second SARS-COV-2vaccine (BNT162B2: Pfizer-biontech) on June 27, 2021, she still reported persistent polydipsia, polyuria, headache, and lethargy. The day after her second vaccination, the patient reported exacerbation of polyuria and polydipsia, with urinary frequency every hour. The daily urinary output was approximately 4 L She also noted worsened headache, excessive fatigue, and multi joint pain. She reported a significant weight loss of a total of 18 kg since the first vaccination. She finally presented to the emergency department of our medical center on August 27, 2021 for increasing fatigue, intolerable polydipsia, polyuria, headache with nausea emesis, and light-headedness. She denied syncopal episodes, vision changes, and altered mental status. Upon history taking. She admitted no menses since the first vaccination. Prior to that. Her menses had been regular. Her family history was unremarkable for autoimmune disease. Conclusion: report a rare case of possible SARS-COV-2 vaccine-related hypophysitis, Which led to diabetes insipidus. Endocrinopathy after SARS-COV-2 vaccination is, indeed, possible Endocrinopathy is associated with infrequent complications; however, it may be underestimated in the post-sars-cov-2-vaccinated population. Further studies are warranted to better understand endocrinopathy and its possible association with SARS-COV-2 vaccination. Sender's Comments: Based on the current available limited information in the case provided, the causal association between the events Hypophysitis and Diabetes insipidus and the use of suspect product BNT162b2 cannot be fully excluded. The case will be reassessed once further information is available The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to RAs, Ethics Committees, and Investigators, as appropriate., Linked Report(s) : PFIZER INC-PV202200133670 Same article/drug/event/patient, different dose;