Endocrine Abstracts

Hemorrhagic fever with renal syndrome (HFRS) is a severe systemic infection caused by hantaviruses that included Hantaan, Seoul, Dobrava, Saaremaa, and Puumala. In Korea, the most common virus is Hantaan. The classical symptoms of HFRS are fever, hemorrhage, hypotension, and renal failure, but the clinical course can be very diverse. Among them, endocrinologic complications, such as hypopituitarism were developed rarely by HFRS. A 49 years-old man admitted our hospital with fever, myalgia and thrombocytopenia. He was diagnosed as HFRS caused by Hantaan and clinical manifestations. In oliguric phase of renal failure, abnormalities of thyroid function, fT4 0.35 ng/dl (0.89–1.78), T3 24.43 ng/dl (60–180) and TSH 0.358 uIU/ml (0.55–4.78), were found and other hormone tests were performed for differential diagnosis. The level of basal hormones were prolactin 13.77 ng/ml (2.1–17.7), GH 2.10 ng/ml (0–1), IGF1 112.87 μg/l (124–310), ACTH 27.8 pg/ml (10.0–60.0), cortisol 13.82 μg/dl (5.27–22.45), LH 3.94 mIU/ml (1.5–9.3), FSH 2.75 mIU/ml (1.4–18.1) and testosterone 104.99 ng/dl (241–827). These results indicated secondary hypogonadism and hypothyroidism and no evidence/was seen hypothalamic or other pituitary disease by sella MRI. According to this result, partial hypopituitarism by HFRS was suspected in the patient. After conservative treatment, manifestations and laboratory investigation were improved. He was discharged and tested the basal hormones again at the outpatient clinic. The results were fT4 1.16 ng/dL, T3 110.43 ng/dl, TSH 1.490 uIU/ml, prolactin 8.27 ng/ml, GH 0.41 ng/ml, IGF1 254.24 μg/l, ACTH 30.9 pg/ml, cortisol 10.36 μg/dl, LH 2.83 mIU/ml, FSH 6.54 mIU/ml and testosterone 214.05 ng/dl. The thyroid function was recovered to normal level spontaneously and the gonadal hormones were still low level. Compared with initial hormone level, the pituitary function is recovering sequentially. Our experience suggests the important to investigate the endocrinologic complications of HFRS and to determine whether treatment of hormone replacement is needed.