800 - Rehabilitation Course After COVID-19 Induced Pituitary Apoplexy with the Rare Complication of Central Diabetes Insipidus

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

JO

Joshua J. Outslay, DO

Resident Physician
SUNY Upstate Medical University
Liverpool, New York, United States

Co-Author(s)

AN

Andreea Nitu-Marquise, MD

Assistant Professor
SUNY Upstate
Skaneateles, New York, United States
MT

Margaret A. Turk, MD

Vice-Chair; SUNY Distinguished Service Professor
State University of New York (SUNY) Upstate Medical University PM&R Program
Syracuse, New York, United States

Submitter(s)

JO

Joshua J. Outslay, DO

SUNY Upstate Medical University
Liverpool, New York, United States

Case Diagnosis: Pituitary apoplexy (PA) secondary to COVID-19 disease and complicated by central diabetes insipidus (CDI) requiring inpatient rehabilitation.

Case Description: A 68-year-old female with a history of prolactinoma s/p resection 10 years prior presented to an acute care facility 3 days after the onset of COVID-19 with headache, nausea, diplopia, and bitemporal visual field defects. Computed Tomography/Magnetic Resonance Imaging showed interval enlargement of known prolactinoma with heterogenous enhancement concerning for hemorrhage and PA. She underwent emergent Trans-Nasal Trans-Sphenoidal re-resection. She developed central hypothyroidism and secondary adrenal insufficiency. She was discharged to a skilled nursing facility rehabilitation unit requiring total assistance for self-care and mobility. Her progress over next few weeks was slow and she began to experience significant nocturia, further impacting her ability to participate in therapy and hindering her progress. She was diagnosed with central diabetes insipidus, and after starting desmopressin, she made significant improvement. Within a month she reached independence for mobility and ADLs.

Discussions: PA is a rare syndrome with a reported incidence of 0.6-13% in pituitary tumors. CDI, due to posterior pituitary involvement, is uncommon in PA, reported to affect < 5% of cases and is typically transient. Underlying mechanisms include mass effect on the pituitary stalk or hypothalamus, vascular compromise, or steroid-induced unmasking. COVID-19 has been linked in ~10 reported PA cases, possibly due to hypothalamic/stalk damage from viral invasion via Angiotensin-converting Enzyme 2 receptors or coagulopathy, although no exact mechanisms have been established. While there have been some cases of COVID-induced CDI, there is only one other reported case of COVID-induced PA involving CDI as a complication. Treatment of CDI highlights the need to address all aspects of care to enhance functional recovery of rehabilitation patients.

Conclusions: Physiatrists play a crucial role in identifying and treating rare complications that hinder patient’s functional gains.