Endocrine Abstracts

Six years after hemorrhagic fever with renal syndrome (HFRS) 73 years old man was admitted in hospital because of hyponatremia (Na 129 mmol/l) and abdominal pain. Before HFRS he was treated for pancreatitis, hypertension, ulcerative colitis and gallstones. In the year 2002 he was admitted with fiver, vomiting, diarrhoea, headache and blurred vision. Serologic immunoflourescence testing was positive for Hantaan (Puumala) virus. During the hospital course haemodialysis was necessary and disseminated intravascular coagulation was present. Despite renal recovery he described loss of appetite and weight, tiredness, occasional constipation, bradycardia and cold intolerance. Slowly he lost libido and axillary hair. In 6 years he was eight times hospitalized. Urethral stricture and sclerosis colli vesicae urinariae was operated (2002, 2004). Blood in stool with diarrhoea, later he was treated for constipation. Because of syncope and bradycardia was implanted pace maker. In the year 2005 he was again on infection depp. With disorientation, fever, prostration and hypotension. Virus pneumonia was suspected. He prepared himself for colonoscopy and was admitted in hospital in the year 2006 because of hypoglycaemia (glucose 2.2 mmol/l) and hyponatremia. Two days after discharged he was admitted in neurological depp. because of vertigo and diplopia. In four of this eight hospitalisation patient was hyponatremic (lowest value 125 mmol/l) what was corrected during hospital treatment.

On last hospitalisation endocrine functions was examined. Hypothyrosis (TSH 0.297 mIU/l, FT₄ 6.68, FT₃ < 0.4 pmol/l), adrenal insufficiency (morning cortisol < 20, short ACTH stimulation test: cortisol 53 121 nmol/l) and hypogonadotropic hypogonadism (FSH 0.5, LH < 0.1 mIU/ml, testosterone 0.4 nmol/l) were found out. Prolactin level was low-normal. Brain computer tomography was normal. Hypopituitarism was established and replacement therapy was begun.

Hypopituitarism is rarely considered after HFRS. We should suspect it, even after many years.