Hypophyseal Hemorrhage and Panhypopituitarism during Puumala Virus Infection: Magnetic Resonance Imaging and Detection of Viral Antigen in the Hypophysis

Hautala, Timo; Sironen, Tarja; Vapalahti, Olli; Pääkkö, Eija; Särkioja, Terttu; Salmela, Pasi; Vaheri, Antti; Plyusnin, Alexander; Kauma, Heikki

doi:10.1086/340859

Cited by 86 publications

(117 citation statements)

References 19 publications

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“…Previous case reports of severe HFRS have described hypophyseal hemorrhage and panhypopituitarism associated with PUUV and HTNV infections [7][8][9][10][11][35][36][37][38]. The development of hypophyseal hemorrhage and subsequent panhypopituitarism has varied from acute to subacute.…”

Section: Discussionmentioning

confidence: 99%

“…There are case reports of hypophyseal hemorrhage and panhypopituitarism in patients with acute NE [7][8][9][10][11]. Postmortem studies of patients with HTNV-induced HFRS, as well as in the few fatal cases of NE, have revealed hemorrhage and necrosis of the pituitary gland in 50-100 % of the autopsies [11][12][13].…”

mentioning

confidence: 99%

“…Postmortem studies of patients with HTNV-induced HFRS, as well as in the few fatal cases of NE, have revealed hemorrhage and necrosis of the pituitary gland in 50-100 % of the autopsies [11][12][13]. 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].…”

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…Almost 100% of infected persons recover, and long-lasting complications are rare. The few fatal cases reported ( 8 , 9 ) showed no apparent geographic clustering. Thus, whether more severe illness could be connected to certain genetic variants of PUUV remains unknown.…”

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confidence: 86%

Analysis of Complete Puumala Virus Genome, Finland

Plyusnina¹,

Razzauti²,

Sironen³

et al. 2012

Emerg. Infect. Dis.

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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%

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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Hypophyseal Hemorrhage and Panhypopituitarism during Puumala Virus Infection: Magnetic Resonance Imaging and Detection of Viral Antigen in the Hypophysis

Cited by 86 publications

References 19 publications

Hormonal deficiencies during and after Puumala hantavirus infection

Hormonal deficiencies during and after Puumala hantavirus infection

Analysis of Complete Puumala Virus Genome, Finland

Panhypopituitarism Following Hemorrhagic Fever with Renal Syndrome Due to Hantavirus

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