Hormonal deficiencies during and after Puumala hantavirus infection

Abstract

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...

Community Acquired Severe Acute Kidney Injury Caused by Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Has a Favorable Outcome

“…Thus, the overall long-term outcome of acute PUUV infection seems favorable. Nevertheless, although the general prognosis of PUUV infection is positive, the development of a chronic hormonal deficit following PUUV infection with pituitary involvement remains a possibility [41]. The long-term outcome, with reference to renal function, blood pressure, urinary protein excretion or the occurrence of hormonal defects, cannot be predicted by the clinical severity of acute PUUV infection [33,41].…”

“…The study cohort consisted of 556 PUUV-infected patients, who had participated in our previous clinical studies [12,17,18,19,24,25,26,27,28,29,30,31,32,33,34,37,38,39,40,41]. The diagnosis of acute PUUV infection was serologically confirmed in all cases.…”

Hantavirus protein interactions regulate cellular functions and signaling responses

“…There are several reports on possible long-term consequences of HFRS [2], and recently this has also been investigated for HCPS [62,63]. The long-term consequences reported are most often mildly affected renal and lung function and blood pressure [62][63][64][65][66], but chronic hormonal deficiencies requiring hormone-replacement therapy have also been observed [2,67]. A follow-up 10 years after PUUVinfection revealed no clear long-term consequences [68], suggesting that hantaviruses normally do not cause long-term consequences.…”

Hypopituitarism in Men with History of Hypovolemic Shock

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