Introduction: Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions of people, causing the COVID-19 global pandemic. The use of novel technologies led to the development of different types of SARS-CoV-2 vaccines that have reduced severe disease courses and related deaths. Besides the positive impact of vaccination on the pandemic, local and systemic side effects have been reported; they are usually mild to moderate, although also serious adverse events have been described. Case Presentation: A 21-year-old female was referred to our hospital for the recent onset of severe polyuria and polydipsia, with the need for about 8 liters of daily water intake. The symptoms developed seven days after the administration of the second dose of the mRNA-based (Pfizer-BioNTech® BNT162b2) SARS-CoV-2 vaccine. In the suspicion of central diabetes insipidus (DI) development, she started treatment with desmopressin (Minirin® tablets) 60 mg/day with an improvement of symptoms and thirst. A thickening of the pituitary stalk was observed at the pituitary MRI with loss of the posterior pituitary bright spot on T1 weighted images. To confirm the diagnosis of central DI, both the water deprivation test and arginine stimulated copeptin test were performed; whilst the former gave no clear-cut indication of DI, the latter showed a reduced copeptin peak after arginine infusion consistent with the diagnosis of partial central DI. Furthermore, the development of symptoms right after the second dose of the vaccine strengthened the hypothesis that DI was related to the vaccination itself. After our evaluation, there was a progressive reduction of desmopressin dose to a complete discontinuation with the maintenance of a normal hydroelectrolytic balance. Clinical and biochemical follow-up was performed by repeating a pituitary MRI and a second arginine-stimulated copeptin test 15 months after the diagnosis. This time, copeptin levels reached a significantly higher peak after arginine stimulation that completely excluded central DI and at pituitary MRI, the thickening of the pituitary stalk previously described was no longer visible. Conclusion: Neurohypophysitis can have an abrupt onset independently of the etiology. Central DI is a rather exceptional event after SARS-CoV-2 vaccination but should be recalled in case of sudden polyuria and polydipsia. DI is indeed reported even after SARS-CoV-2 infection, thus, this report should not discourage the use of mRNA-based vaccines. Furthermore, our case demonstrates that full recovery of posterior pituitary function is possible after immunization with anti-Covid-19 BNT162b2 vaccine. Further studies are needed to clarify the possible mechanism relating to SARS-CoV-2 vaccination and this rare adverse event.

中文翻译：

---

SARS-CoV-2 疫苗接种后短暂性中枢性尿崩症（精氨酸加压素缺乏）：病例报告和文献综述

简介：自 2019 年 12 月以来，严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 已经影响了数百万人，导致了 COVID-19 全球大流行。新技术的使用导致了不同类型的 SARS-CoV-2 疫苗的开发，这些疫苗减少了严重疾病进程和相关死亡。除了疫苗接种对大流行产生积极影响外，还报告了局部和全身副作用；尽管也有严重不良事件的描述，但它们通常是轻度至中度。病例介绍：一名21岁女性，因近期出现严重多尿、多饮，每日需饮水量约8升，入院。注射第二剂基于 mRNA 的 (Pfizer-BioNTech® BNT162b2) SARS-CoV-2 疫苗 7 天后出现症状。由于怀疑患有中枢性尿崩症 (DI)，她开始接受去氨加压素（Minirin® 片剂）60 毫克/天的治疗，症状和口渴得到改善。垂体 MRI 观察到垂体柄增厚，T1 加权图像上垂体后叶亮点消失。为了确诊中枢性尿崩症，进行了禁水试验和精氨酸刺激和肽素试验；前者没有给出明确的 DI 迹象，而后者在精氨酸输注后显示出和肽素峰值降低，这与部分中枢性 DI 的诊断一致。此外，在第二剂疫苗接种后立即出现的症状强化了DI与疫苗接种本身有关的假设。经过我们的评估，去氨加压素的剂量逐渐减少，直至完全停用，同时维持正常的水电解平衡。诊断后 15 个月，通过重复垂体 MRI 和第二次精氨酸刺激和肽素测试进行临床和生化随访。这次，在精氨酸刺激后，和肽素水平达到了明显更高的峰值，完全排除了中枢性DI，并且在垂体MRI中，先前描述的垂体柄增厚不再可见。结论：神经垂体炎可以突然发作，与病因无关。中枢性尿崩症是 SARS-CoV-2 疫苗接种后的一个相当特殊的事件，但应在突然多尿和多饮的情况下进行召回。即使在 SARS-CoV-2 感染后，DI 确实也有报道，因此，该报告不应阻止基于 mRNA 的疫苗的使用。此外，我们的病例表明，使用抗 Covid-19 BNT162b2 疫苗免疫后，垂体后叶功能完全恢复是可能的。需要进一步的研究来阐明与 SARS-CoV-2 疫苗接种和这种罕见不良事件相关的可能机制。