Hypopituitarism as a Late Complication of Hemorrhagic Fever

Abstract

We report three patients who developed hypopituitarism as a late complication of hemorrhagic fever with renal syndrome (HFRS). Their past history, physical examination, and endocrine investigation confirmed hypopituitarism. Magnetic resonance imaging of the pituitary revealed atrophic pituitary gland with an empty sella. Hemorrhagic fever is endemic in certain regions of the Balkans, and this preliminary report suggests the importance of investigating the endocrine status in every patient who survived HFRS.

Imaging of Topographic Viral CNS Infections

“…A number of patients with NE have been found to develop pituitary hemorrhage during or shortly after acute phase of the infection, which is followed by atrophic changes, as demonstrated on MR imaging [41][42][43]. Puumala virus antigen was detected in both neuroendocrine stromal and vascular endothelial cells of the pituitary gland.…”

“…Puumala virus antigen was detected in both neuroendocrine stromal and vascular endothelial cells of the pituitary gland. The patients develop panhypopituitarism as a late complication with an empty sell appearance on MR imaging [42,43]. Acute disseminated encephalomyelitis (ADEM) is usually an acute monophasic inflammatory and demyelinating disease of the CNS occurring days to weeks after various viral infections or vaccinations.…”

Panhypopituitarism Following Hemorrhagic Fever with Renal Syndrome Due to Hantavirus

“…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.…”

Hypopituitarism in Men with History of Hypovolemic Shock

“…Hypopituitarism associated with hemorrhagic fever with renal syndrome has been described [9]. This viral infection is caused by hantaviruses, and its clinical course is characterized by fever, circulatory collapse with hypotension, hemorrhages, and renal failure [10].…”