Case-based learning enhances clinical competencies in Thai veterinary students: a mixed-methods approach.

Coronavirus disease 2019 (COVID-19) is the disease caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. While infection manifests itself predominantly as an acute respiratory illness, many affected patients also develop persistent, long-term symptoms affecting a variety of organ systems following resolution of the acute phase, often termed ‘long COVID’. One area of particular interest to endocrinologists is the impact on the pituitary gland, with previous case studies describing hypopituitarism, pituitary apoplexy and syndrome of inappropriate antidiuretic hormone developing shortly following COVID-19 infection (). SARS-CoV-2’s entry into the cell is dependent on the binding of its spike protein to the ACE2 cell receptor (). Notably, ACE2 has also been found to be expressed in the pituitary gland (). However, at present, it is unclear whether COVID-19-associated pituitary dysfunction is mediated by direct viral invasion and destruction, or by an immune-mediated inflammatory response against the pituitary gland precipitated by acute infection. One specific syndrome resulting from pituitary dysfunction is arginine vasopressin deficiency (AVP-D). AVP-D is defined by an insufficient production of arginine vasopressin from the posterior pituitary, with resulting loss of activation of the V2 receptor in the collecting ducts of the kidney causing significant polyuria and natriuresis. Herein, we describe a case of a patient presenting with AVP-D developing two weeks following COVID-19 infection.