Dear Editors,
Vaccines against coronavirus disease 2019 (COVID-19) have been shown to protect against at least the severe forms and to reduce mortality among infected patients. All published cases of adverse events were not intended to discuss the value of the vaccine in preventing serious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.
However, adverse events, especially those related to pituitary diseases, should be reported. Whether in the case of hypophysitis or apoplexy (the two major forms of pituitary lesions reported), the prognosis may be compromised due to corticotroph, thyroid or vasopressin deficiencies [1], [2]. We strongly believe that these adverse effects are not numerous since there are only about ten of them to date. The main reason in our opinion is because they can be confused with post-vaccination symptoms such as asthenia, headaches, nausea… However, these symptoms, in view of a careful clinical examination, can be linked to an inflammation or ischemia of the pituitary gland (symptoms intensity depending on the extension of the damage). Moreover, we have observed that many patients recovered from their post-vaccination's symptoms after several weeks, as for the recovery of post-vaccination pituitary's lesions [1], [2].
The main aim of our paper was to shed light on these symptoms in order to warn clinicians of insidious pituitary's adverse events [1]. These symptoms are impossible to predict except possibly by genetic predisposition's studies [3]. Analyzing all patients before their vaccination by a pituitary hormonal screening is also practically impossible and would amount to exploring all patients on all other systems affected by post-vaccination adverse effects (pancreas, thyroid, adrenal, liver...) [4]. Concerning the pathophysiology of the lesions, we agree with many authors that it can be related to a post-ASIA syndrome, by the mimicry of adjuvant proteins or by an inflammatory mechanism. These mechanisms are being reported and are the subject of numerous reviews [5].
Disclosure of interest
The authors declare that they have no competing interest.
References
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