High Risk of Hypopituitarism in Patients Who Recovered from Hemorrhagic Fever with Renal Syndrome

Stojanović, Marko; Pekić, Sandra; Cvijović, Goran; Miljić, Dragana; Doknic, Mirjana; Nikolic-Djurovic, Marina; Micić, Dragan; Hrvacević, R; Nešić, Vladimir; Popović, Vera

doi:10.1210/jc.2008-0311

Cited by 41 publications

(40 citation statements)

References 30 publications

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“…In a recent retrospective Serbian study the prevalence of any endocrine deficiency 2 years after HFRS was 18 % [14].…”

Section: Discussionmentioning

confidence: 98%

“…PUUV antigen has been detected in hypophyseal neuroendocrine and endothelial cells of a patient with fatal NE [8]. In a recent retrospective Serbian study of 60 adults with a previous HFRS, a high prevalence of hypopituitarism was identified after recovery from HFRS [14]. Immunological factors including tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) have been suggested to be involved in the pathogenesis of NE [15].…”

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confidence: 99%

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Hormonal deficiencies during and after Puumala hantavirus infection

Mäkelä¹,

Jaatinen²,

Miettinen³

et al. 2010

Eur J Clin Microbiol Infect Dis

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Purpose: Previous reports have described panhypopituitarism associated with severe cases of hemorrhagic fever with renal syndrome (HFRS), but the prevalence of hormonal deficiencies after nephropathia epidemica (NE), a milder form of HFRS, has not been studied. This study was conducted to determine the prevalence of hormonal defects in patients with acute NE and during long-term follow-up. Methods: Fifty-four patients with serologically confirmed acute NE were examined by serum hormonal measurements during the acute NE, after 3 months, and after 1 to 10 (median 5) years. Results: Thirty out of 54 (56%) patients had abnormalities of the gonadal and/or thyroid axis during the acute NE. After a median follow-up of 5 years, 9 (17%) patients were diagnosed with a chronic, overt hormonal deficit: hypopituitarism was found in 5 patients and primary hypothyroidism in 5. In addition, chronic subclinical testicular failure was found in 5 men. High creatinine levels and inflammatory markers during NE associated with the acute central hormone deficiencies, but not with the chronic ones. Conclusions: Hormonal defects are common during acute NE and surprisingly many patients develop chronic hormonal deficiencies after NE. The occurrence of long-term hormonal defects cannot be predicted by the severity of acute NE. According to the reviewer's advice, we have now added two new tables (Tables 3 and 4) to clarify the presentation of the observations. Table 3 shows the clinical diagnoses and serial plasma hormone levels in those 9 NE patients who presented with chronic, overt hormonal deficits. In Table 4, we show the acute-phase clinical and laboratory findings of the 9 patients, who developed chronic hormonal defects after NE, compared to those 45 patients, whose hormone levels remained normal during the follow-up. Since the clinical diagnoses of hormonal deficiencies are now shown in Table 3 (in the revised version), we have omitted the corresponding text from Results, Hormonal deficiencies: "Of these 9 patients, 2 were diagnosed with isolated central hypogonadism, 2 had multiple pituitary hormone deficiencies, 2 had primary hypothyroidism only, one had primary hypothyroidism and primary hypogonadism, one was diagnosed with isolated central hypogonadism and peripheral hypothyroidism, and one with primary hypothyroidism and a possible GH deficiency (undetectable GH level and IGF-1 6.5 nmol/l; reference range 10-29 nmol/l)." In order to further clarify the results, we have also referred to the patients described in Table 3 (e.g. "patient 1, table 3") in the revised text: Results, page 8, Hormonal deficiencies, lines 6 and 12, as well as in Results, Imaging studies, page 9, the first and the third line). We have omitted the following text from Results, Imaging studies: "Testo 11.6-10.8-8.1-7.4 nmol/l, LH 1.6-1.4-2.0-2.6 U/l, fT4 12.5-11.8-10.4-10.4 pmol/l, and TSH 1.2-1.1-1.0-0.9 mU/l, measured in the acute phase, and after 1 year, 5 and 9 years, respectively", since the same values are now shown in Table 3 (patient 2) o...

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“…In a recent retrospective Serbian study the prevalence of any endocrine deficiency 2 years after HFRS was 18 % [14].…”

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Hormonal deficiencies during and after Puumala hantavirus infection

Mäkelä¹,

Jaatinen²,

Miettinen³

et al. 2010

Eur J Clin Microbiol Infect Dis

View full text Add to dashboard Cite

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“…Hypopituitarism associated with hemorrhagic fever with renal syndrome has not been reported elsewhere (4)(5)(6)(7)(8). The exact mechanism of the hypopituitarism is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Pekic et al (8) described the first report of hypopituitarism that developed as a sequel of HFRS in the region of the Balkans and then sporadic cases have been presented. They reported three cases 24 They found a high prevalence of hypopituitarism (18.3%) in patients who recovered from HFRS many years ago.…”

Section: Discussionmentioning

confidence: 99%

Panhypopituitarism Following Hemorrhagic Fever with Renal Syndrome Due to Hantavirus

Kayabaş¹,

Akgün²,

Atilla³

et al. 2015

JAEMCR

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Introduction: Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease caused by viruses that belong to the genus Hantavirus. Hantaviruses produce a spectrum of illness characterized by fever, circulatory collapse, hemorrhages, and renal failure. Pituitary ischemia/infarction and necrosis are known causes of hypopituitarism, often remaining unrecognized because of subtle clinical manifestations. In this report, we present a case of a 60-year-old male patient who was referred to the emergency department (ED) for unexplained hypoglicemia, with panhypopituitarism following HFRS.

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“…A large study investigated patients two years after CNS infections, and isolated corticotroph deficiency was diagnosed in some patients (66 (78,79). In a large retrospective study (60 adults who recovered from HFRS), high prevalence of partial or complete hypopituitarism was found in HFRS survivors (80). In a recent study, a group of patients suffering from Puumala hantavirus infections were followed long term.…”

Section: Viral Hypophysitismentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Expanding the cause of hypopituitarism

Pekić

Popović

2017

European Journal of Endocrinology

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Hypopituitarism is defined as one or more pituitary hormone deficits due to a lesion in the hypothalamic-pituitary region. By far, the most common cause of hypopituitarism associated with a sellar mass is a pituitary adenoma. A high index of suspicion is required for diagnosing hypopituitarism in several other conditions such as other massess in the sellar and parasellar region, brain damage caused by radiation and by traumatic brain injury, vascular lesions, infiltrative/immunological/inflammatory diseases (lymphocytic hypophysitis, sarcoidosis and hemochromatosis), infectious diseases and genetic disorders. Hypopituitarism may be permanent and progressive with sequential pattern of hormone deficiencies (radiation-induced hypopituitarism) or transient after traumatic brain injury with possible recovery occurring years from the initial event. In recent years, there is increased reporting of less common and less reported causes of hypopituitarism with its delayed diagnosis. The aim of this review is to summarize the published data and to allow earlier identification of populations at risk of hypopituitarism as optimal hormonal replacement may significantly improve their quality of life and life expectancy.Correspondence should be addressed to V Popovic

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High Risk of Hypopituitarism in Patients Who Recovered from Hemorrhagic Fever with Renal Syndrome

Cited by 41 publications

References 30 publications

Hormonal deficiencies during and after Puumala hantavirus infection

Hormonal deficiencies during and after Puumala hantavirus infection

Panhypopituitarism Following Hemorrhagic Fever with Renal Syndrome Due to Hantavirus

DIAGNOSIS OF ENDOCRINE DISEASE: Expanding the cause of hypopituitarism

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