title: Acute and chronic pituitary failure resembling Sheehan's syndrome following bites by Russell's viper in Burma.
abstract: Pituitary function was investigated in 9 patients in shock after Russell's viper bites and in 24 individuals who had been severely envenomed 2 weeks to 24 years previously. 3 out of 9 patients had hypoglycaemia and inappropriately low serum cortisol, plasma growth hormone, and plasma prolactin concentrations. 4 who died had pituitary haemorrhage and 1 had adrenal haemorrhage as well. Of the 24 who had apparently recovered from bites, 7 had clinical features of hypopituitarism and no response in plasma growth hormone or prolactin concentrations to symptom-producing insulin-induced hypoglycaemia. 4 of these 7 had a sluggish serum cortisol response to 'Synacthen Depot' and 5 had an abnormal cortisol response to hypoglycaemia. 4 men with symptoms who were tested had low serum testosterone concentrations; serum thyroxine was also low in these men but not in 2 women with menstrual disturbances and impaired insulin responses. Of the 17 individuals without clinical evidence of endocrine disease, 4 had pituitary hormonal abnormalities. Russell's viper envenoming may thus produce a disorder resembling Sheehan's syndrome.
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000382:Agricultural Workers' Diseases; D002908:Chronic Disease; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007018:Hypopituitarism / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D002052:Myanmar; D011446:Prospective Studies; D012909:Snake Bites / Q000097:blood / Q000150:complications*; D014757:Viper Venoms / Q000506:poisoning
chemical_list: D006728:Hormones; D014757:Viper Venoms