Arginine vasopressin deficiency onset after COVID-19 vaccination with positive anti-rabphilin-3A antibodies: a case report and literature review

• Published in: BMC endocrine disorders Vol. 24; no. 1; pp. 143 - 7
• Main Authors: Takizawa, Hiroki, Goto, Hiromasa, Uchida, Toyoyoshi, Aoyama, Shuhei, Fujisawa, Haruki, Iwata, Naoko, Suzuki, Atsushi, Sugimura, Yoshihisa, Watada, Hirotaka
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06-08-2024; BioMed Central; BMC
• Subjects: Adaptor Proteins, Signal Transducing - immunology; Adjuvants; Aged; Anti-rabphilin-3A antibodies; Antibodies; Arginine; Arginine Vasopressin; Arginine vasopressin deficiency; Argipressin; Autoantibodies - blood; Autoantibodies - immunology; Biopsy; Case Report; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - immunology; COVID-19 - prevention & control; COVID-19 vaccines; COVID-19 Vaccines - adverse effects; Development and progression; Diabetes; Differential diagnosis; Disease; Enlargement; Female; Health aspects; Humans; Infection; Infections; Inflammation; Literature reviews; Lymphocytic infundibulo-neurohypophysitis; Magnetic Resonance Imaging; Malignancy; Patients; Pharmaceutical industry; Pituitary; Pituitary (posterior); Polydipsia; Polyuria; Proteins; SARS-CoV-2 - immunology; SARS-CoV-2 vaccine; Severe acute respiratory syndrome coronavirus 2; Steroids; Urine; Vaccination; Vaccination - adverse effects; Vasopressin; Japan; Arginine vasopressin deficiency; SARS-CoV-2 vaccine; Lymphocytic infundibulo-neurohypophysitis; Anti-rabphilin-3A antibodies
• ISSN: 1472-6823; 1472-6823
• DOI: 10.1186/s12902-024-01664-8

Arginine vasopressin deficiency (AVP-D) can occur due to various conditions, so clarifying its cause is important for deciding treatment strategy. Although several cases of AVP-D following coronavirus disease 2019(COVID-19) infection or COVID-19 vaccination have been reported, the diagnosis of the underlying disease has not been reported in most cases.
A 75-year-old woman who presented with polydipsia and polyuria 9 weeks after contracting COVID-19 and 5 weeks after receiving the SARS-CoV-2 vaccination, leading to the final diagnosis of AVP-D 8 months after the first appearance of symptoms. Interestingly, pituitary magnetic resonance imaging (MRI) still revealed stalk enlargement frequently observed in patients with SARS-CoV-2 vaccination-induced AVP-D. Although this finding could not rule out any malignancies, we additionally measured anti-rabphilin-3A antibodies, a known marker for lymphocytic infundibulo-neurohypophysitis (LINH), and found that the results were positive, strongly suggesting LINH as the cause of this disease. Thus, we avoided pituitary biopsy. At the follow-up MRI conducted 12 months after the initial consultation, enlargement of the pituitary stalk was still observed.
We experienced a case with LINH probably induced by SARS-CoV-2 vaccination. In SARS-CoV-2 vaccination-related LINH, unlike typical LINH, there is a possibility of persistent pituitary stalk enlargement on MRI images for an extended period, posing challenges in differential diagnosis from other conditions. Pituitary stalk enlargement and positive anti-rabphilin-3A antibodies may help in the diagnosis of AVP-D induced by SARS-CoV-2 vaccination.