Endocrine Abstracts

Introduction: Russell’s Viper is a venomous snake found in South and South East Asia. The snake bite causes coagulopathy, neurotoxicity, renal failure, local effects and even death. But hypopituitarism is an extremely rare complication¹. There are only a few case reports from India and Burma and we report the first case from Sri Lanka.

Case report: A 49 year old man from a remote part of Sri Lanka was bitten by a Russell’s viper 3 years ago. He felt faint and started vomiting and also noticed swelling of the bitten foot and bleeding from the varicose veins. He recovered following treatment with antivenom serum. Over the next 3 years he was feeling unwell with generalised weakness of the body, lethargy, sleepiness and reduced libido. He did not have sinister headache or visual disturbance. On examination he had an apathetic face but with preserved secondary sexual characteristics. The visual fields and fundi were normal. The pituitary function tests revealed panhypopituitarism. FT4 0.87 ng/dl, TSH 1.85 mIu/ml, 9 am Cortisol 2.5 mcg/dl, IGF1 145 ng/ml, Prolactin 2.7 ng/ml, FSH 2.6 μ/ml, LH 1.5 μ/ml, Testosterone 1.92 ng/ml. The MRI of the pituitary was normal. He was treated with Hydrocortisone, Levothyroxine and Testosterone which brought about marked improvement in his symptoms and general well being.

Discussion: Viper bite could lead to hypopituitarism. This is probably due to the procagulants in Russell’s viper venom that cause pituitary damage through Disseminated Intravacular Coagulation. As unrecognized hypopituitarism can be potentially fatal physicians should have a high degree of suspicion. Chronic ill health in those who apparently recover from the acute envenomation should alert the physician regarding the possibility of hypopituitarism.

Reference: Helen T & JAH Wass. Oxford Handbook of Endocrinology and Diabetes, 98–102. London: Hypopituitarism Oxford University Press, 2009.