8147 Central Diabetes Insipidus Following COVID-19 Infection: An Unusual Complication

Abstract Disclosure: L. Bernacet Rivera: None. S.E. Inzucchi: None. SARS-CoV 2 infection has been associated with organ-specific complications since the 2020 pandemic, including several endocrinopathies. This has been mostly theorized to be related to high expression of angiotensin-receptor enzyme 2 (ACE-2) receptors in the endocrine system. Since the virus’ main mechanism of entry to host cells is via these receptors, endocrine glands may thus be susceptible for injury. A rarely described complication is isolated central diabetes insipidus (DI). We present a woman who developed spontaneous central DI soon SARS-CoV infection, without other cause. A 41-year-old woman with medical history of gastroesophageal reflux presented to the clinic for evaluation of polydipsia and polyuria. She contracted COVID 19 infection about 3 months prior to presentation. She had mild symptoms and did not require hospitalization or any pharmacological treatment. Approximately 3 weeks following infection she noticed the sudden development of increased urination and thirst. She reported urinating approximately every 2 hours (including 3-4 times overnight) and drinking 1-1.5 gallons of fluid daily, much more than her baseline. Given persistence of symptoms she sought medical attention at a local emergency room (ER) for further evaluation. There was no history of prior pituitary disease, brain masses, head trauma, granulomatous conditions. Workup was significant for serum sodium of 142 mmol/L and urine specific gravity <1.005. She was discharged from the ER to follow with her primary care provider. Patient had a 24-hour urine collection which yielded 6.1 L, with an osmolality of 93 mOsm/kg, while her serum sodium concentration was 141 mmol/L. Pituitary hormonal workup had normal levels of morning cortisol , free T4, TSH, prolactin, LH, FSH, and IGF-1. Due to normal serum osmolality at the time of the urine collection, the patient underwent an overnight water deprivation test of 12 hours to determine etiology of her polyuria. This resulted in a serum sodium of 148 mmol/L, serum osmolality of 300 mOsm/kg, urine osmolality of 159 mOsm/kg, and low serum copeptin level 2 pmol/L confirming the diagnosis of central DI. Patient was initiated on oral DDAVP with improvement in symptoms. A pituitary MRI revealed thickening of the pituitary infundibulum to 4 mm. The presence of central DI and thickening of pituitary stalk were suggestive of infundibuloneurohypophysitis. Other laboratory testing was negative and there was no other explanation for her condition. Follow-up pituitary MRI has shown no change in the pituitary stalk over a one-year period. The relationship between SARS-CoV 2 infection and this patient’s DI remains unclear but the temporal association and lack of other systemic related conditions makes it as strong possibility. They have been case reports with isolated central DI following COVID-19 infection. The pathogenesis remains unclear, but likely involves immune activation. Presentation: 6/2/2024