Endocrine Abstracts

Background: The partial or complete hypopituitarism is described as late complication of hemorrhagic fever with renal syndrome (HFRS). Imaging methods of pituitary gland examination in the chronic phase showed pituitary atrophy, but a precise pathogenic mechanism that causes pituitary damage in HRFS remains unclear. While hypopituitarism in HFRS is rarely described, cardiac failure as a known complication of hypopituitarism is even more rarely described. We present a case of severe heart failure in a young male patient with unrecognized hypopituitarism consequent to HFRS and undiagnosed hemochromatosis.

Case Presentaton: 42-year-old male patient was admitted at the Department of Endocrinology of University Clinical Centre of Republic of Srpska with suspected hypopituitarism. He managed to walk with the help of another person, and his speech was incoherent and with difficulties. The patient was pale, facial and body hairless with adynamia, myxedema, hypotension, and bilateral gynecomastia with decreased libido and impotency. Echocardiography verified a global reduction in myocardial contractility, dilated left atrium and ventricle, with low ejection fraction (10-15%). Results of hormone tests confirmed diagnosis of panhypopituitarism, and replacement therapy (hydrocortisone, levothyroxine and testostreone) was started. MRI of the pituitary gland was performed and it showed an “empty sella”. On the third day after the therapy was introduced, the patient started to speak clearly and mental status was stabilized. The patient was independently mobile after seven days. Echocardiography performed a month after the replacement therapy was introduced showed an improvement in myocardial contractility with normal dimensions of the atrium and ventricle and estimated EF of 40%. Additionally, the diagnose of chemochromatosis was confirmed by genetic analysis of the HFE gene and presence of homozygosity for mutation pH63D (c 187 >G), but the specific therapy was not initiated. At follow-up visit, 6 months after introduction of replacement therapy, the patient felt well, performed usual physical activities, male type of facial and body hair distribution recovered, his sexual function normalized, and he had a normal mental status. Echocardiography was completely normal 6 months after introduction of replacement therapy (the left ventricle with normal dimensions, EF 58%).

Conclusion: The heart failure is extremely rare complication of hypopituitarism, but it is usually reversible when hormonal therapy is replaced. According to significant relationship and a high prevalence of hypopituitarism as a consequence of HFRS, endocrinological investigation should be considered in patients with HFRS and clinical signs and symptoms suggestive of hypopituitarism.