Persistent Hypothalamic‐Pituitary Insufficiency Following Acute Meningoencephalitis:

Abstract

ABSTRACT. This report concerns two patients, a 43‐year‐old woman and a 53‐year‐old man, who developed clinical as well as laboratory signs of permanent gonodal and thyroid failure following an acute intracranial infection—in the woman a meningoencephalitis of unknown origin, and in the man an encephalitis caused by Coxsackie B5. Endocrine investigations were compatible with hypothalamicpituitary dysfunction, with some of the results favoring a hypothalamic lesion. Perhaps hormone deficiency of hypothalamic and/or pituitary origin is a more common sequel of acute meningoencephalitis than has hitherto been reported.

Hypothalamic–pituitary insufficiency following infectious diseases of the central nervous system

“…In only one patient (15), imaging of the head had been performed during acute illness, revealing no abnormalities of the pituitary gland or hypothalamus. In earlier case reports, endocrine investigations and elevated basal PRL levels (probably due to the loss of tonic inhibition of the pituitary lactotrophs by the hypothalamus) were suggestive of a hypothalamic rather than a pituitary lesion (14,16,18). On the contrary, in other patients, the pituitary gland seemed directly affected (15,17).…”

“…A CT of the head revealed a contrast-enhanced suprasellar lesion in this particular patient (19). The endocrine deficiencies reached from complete panhypopituitarism including diabetes insipidus (14)(15)(16)18) to various partial defects (14,15,17). Data of these patients are given in Table 4.…”

“…Reports of anterior pituitary dysfunction following infectious diseases of the CNS are rare, and the incidence has not yet been studied systematically. In almost all reported cases, the anterior pituitary insufficiency was caused by viruses (14)(15)(16)(17)(18), and only one bacterial meningoencephalitis associated with diabetes insipidus and suspected corticotropic insufficiency has been reported. A CT of the head revealed a contrast-enhanced suprasellar lesion in this particular patient (19).…”

“…Three of the patients with corticotropic insufficiency in our study had suffered from meningitis of unknown origin; in one patient meningitis caused by enterovirus had been diagnosed. It has been suggested that focal neurological symptoms from the basal regions of the brain might be suggestive of an increased risk of hypothalamic-pituitary damage (14,15), but heterogeneous neurological deficits have been reported in affected patients. Few patients (15) and also all patients with corticotropic deficiency in our study had presented with symptoms of general illness (cephalgia, myalgia, fever), but no neurological deficits at all.…”

“…In most of the early case reports, the deficient hormone secretion has been caused by tuberculous meningitis (11)(12)(13). There are, however, reports to show that other infectious agents may also cause hypothalamic-pituitary dysfunction (14)(15)(16)(17)(18)(19). Therefore, the aim of the present investigation was to determine the incidence of hypothalamic-pituitary insufficiency in patients with previous infectious diseases of the CNS of different etiologies and mild-to-moderate clinical course.…”