Hypopituitarism might have a bidirectional relationship with COVID-19 due to its frequent association with metabolic comorbidities like obesity, diabetes, arterial hypertension, and vertebral fractures. In a large population matched cohort study, hospitalized patients with hypopituitarism were highly vulnerable for acute medical conditions with increased risk of mortality and adverse clinical outcomes. Recently, COVID-19 has been highlighted as a probable risk factor for pituitary apoplexy.
Autoptic and radiological studies have shown the possible relationships of viral infectious diseases with direct pituitary vascular damage with ischemic and hemorrhagic signs, and foci of necrosis. Moreover, increased stimulation of the pituitary gland during an infectious stress state may increase pituitary blood demand leading to acute apoplexy.
The prolonged use of high-dose exogenous glucocorticoids for treating SARS-CoV-2 may result in suppression of hypothalamic–pituitary–adrenal axis, causing a consequent condition of adrenal insufficiency leading to an increased mortality rate. Moving forward it is seen that decreased GH levels are a common denominator in the elderly and particularly in males; at the same time, the susceptibility of COVID-19 infection has been reported to be age- and sex-dependent. Furthermore, it has been found that a significant number of individuals with hypogonadism have been reported to be infected with SARS-CoV-2.
Published data on the effectiveness of vaccines against COVID-19 have not reported any adverse events or particular contraindications in relation to pituitary diseases and hypopituitarism. Thus vaccines remain the most suitable options to prevent the infection. There is a lack of studies due to the rarity of cases of hypopituitarism which does not allow us to draw a conclusion regarding the association of hypopituitarism and COVID-19. But the complications of hypopituitarism have all been associated with poor outcomes and increased mortality in patients infected by SARS-CoV-2.