Unrecognized chronic hypopituitarism in patients who survived hemorrhagic fever with renal syndrome

M Stojanovic; S Pekic; G Cvijovic; A Kendereski; M Doknic; D Miljic; V Zivkovic; M Djurovic; D Micic; V Popovic

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Endocrine Abstracts (2006) 11 P603

ECE2006 Poster Presentations Neuroendocrinology and behaviour (70 abstracts)

Unrecognized chronic hypopituitarism in patients who survived hemorrhagic fever with renal syndrome

M Stojanovic , S Pekic , G Cvijovic , A Kendereski , M Doknic , D Miljic , V Zivkovic , M Djurovic , D Micic & V Popovic

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Institute of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center, Belgrade, Serbia, Serbia and Montenegro.

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease caused by Hantavirus. One of the rare complications of this disease is hypopituitarism (only sporadically reported) due to hemorrhage, necrosis and atrophy of anterior pituitary lobe. The aim of the study was to investigate the anterior pituitary function in patients who recovered from HFRS.

We evaluated 31 patients (29 male and 2 female), aged 38.7±2.2 years, with BMI 25.7±0.6 kg/m², who recovered from HFRS 5.8±0.8 years ago, and compared them with 31 age-, BMI- and sex-matched control subjects. At baseline, circulating T4, TSH, FSH, LH, testosterone, prolactin, IGF-I and cortisol levels were measured, and insulin-induced hypoglycemia test (ITT) was used to assess GH response, HPA and prolactin. The study was approved by the local Ethical Committee.

According to peak GH levels during ITT (cut-off for GH deficiency <3 μg/l), four patients were diagnosed with severe GH deficiency (GHD, mean GH peak was 0.04±0.02 μg/l). All four exhibited IGF-I values below the normal values for sex and age (34.0±7.8 ng/ml). All had additional pituitary hormone deficits (hypothyroidism, hypogonadism, hypocorticism) including low prolactin levels, suggesting panhypopituitarism (GHD3) i.e. severe damage to the pituitary. MRI of the pituitary revealed atrophic pituitary gland with an empty sella. All four were completely replaced. The rest had normal anterior pituitary function with GH response during ITT not different from control subjects (12.7±1.3 μg/l vs. 13.9±1.7 μg/l, P>0.05).

In conclusion, severe hypopituitarism was diagnosed as a late complication of HFRS in 4 (out of 31) patients (12.9%). The clinical course of the hypopituitarism in all four patients was chronic and undiagnosed for a long period.