Post-herpes encephalitic anterior pituitary insufficiency with hypothermia and hypotension.
A 49-year-old man with herpes simplex encephalitis at age 22 was admitted with hypotension (90/60 mm Hg) and hypothermia (33.7 degrees C). His blood pressure was 80-90/50-60 mm Hg, with temperatures averaging 35 degrees C, for at least 3 years before admission. Evaluation of his hypothermia and hypotension revealed a low free triiodothyronine, low normal thyrotropin, luteinizing hormone < 2 mIU/L, follicle stimulating hormone <3 mIU/L, and low testosterone of 1.39 ng/dL. A baseline cortisol of 13.9 microg/dL was stimulated to 41.8 microg/dL with corticotropin, indicating he had partial anterior hypopituitarism with an intact pituitary-adrenal axis. Posterior pituitary function was normal. MRI revealed a "bright" posterior pituitary on a T1-weighted image, further indicating a normal posterior pituitary. Extensive decreased T1-weighting on MRI in the right and left temporal lobes was consistent with encephalomalacia. With thyroid hormone replacement, his blood pressure increased to 110/70 mm Hg with a temperature of 37 degrees C.
Vesely
D L
DL
Department of Internal Medicine, University of South Florida for Health Sciences, and James A. Haley Veterans Hospital, Tampa 33612, USA.
Mastrandrea
P
P
Samson
C
C
Argyelan
G
G
Charvit
S
S
D003937:Diagnosis, Differential; D020803:Encephalitis, Herpes Simplex / Q000097:blood / Q000150:complications*; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000821:virology*; D007022:Hypotension / Q000097:blood / Q000209:etiology*; D007035:Hypothermia / Q000097:blood / Q000209:etiology*; D007037:Hypothyroidism / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D013963:Thyroid Hormones / Q000097:blood
D012739:Gonadal Steroid Hormones; D013963:Thyroid Hormones