title: High risk of hypopituitarism in patients who recovered from hemorrhagic fever with renal syndrome.
abstract: BACKGROUND
  Hemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses, is a severe systemic infection, with acute shock, vascular leakage, hypotension, and acute renal failure. Pituitary ischemia/infarction and necrosis are known causes of hypopituitarism, often remaining unrecognized due to subtle clinical manifestations. Cases of hypopituitarism after HFRS were previously only sporadically reported.
  
  
  OBJECTIVE
  The aim of this study was to determine, for the first time, the prevalence of hypopituitarism among HFRS survivors.
  
  
  METHODS
  In 60 adults (aged 35.8+/-1.3 yr) who recovered from HFRS 3.7 +/- 0.5 yr ago (median 2 yr), assessment of serum T(4), free T(4), TSH, IGF-I, prolactin, cortisol, and testosterone (in males) was followed by insulin tolerance test and/or GHRH+GH-releasing peptide-6 stimulation tests.
  
  
  RESULTS
  Severe GH deficiency was confirmed in eight of 60 patients (13.3%): in five with multiple pituitary hormone deficiencies (MPHDs) and isolated in three. Thyroid axis deficiency was confirmed in five of 60 patients (8.3%), all with MPHD. Hypothalamus-pituitary-adrenal axis deficiency was observed in six of 60 (10.0%); in five with MPHD and isolated in one. Gonadal axis deficiency was confirmed in seven of 56 male subjects (12.5%): five with MPHD and isolated in two. Overall six patients (10.0%) had a single pituitary deficit (three GH, two gonadal, and one adrenal), and five (8.3%) had MPHD. The prevalence of patients having any endocrine deficiency was 18% (11 of 60).
  
  
  CONCLUSIONS
  A high prevalence of hypopituitarism after recovery from HFRS is identified, with magnetic resonance imaging revealing atrophic pituitary and empty sella. Awareness is raised to neuroendocrine consequences of HFRS because unrecognized hypopituitarism significantly affects the physical and psychological well-being.
authors.affiliation: Neuroendocrine Unit, Institute of Endocrinology, University Clinical Center, Dr Subotica 13, Belgrade, Serbia.
authors.forename: Marko
authors.initials: M
authors.lastname: Stojanovic
authors.forename: Sandra
authors.initials: S
authors.lastname: Pekic
authors.forename: Goran
authors.initials: G
authors.lastname: Cvijovic
authors.forename: Dragana
authors.initials: D
authors.lastname: Miljic
authors.forename: Mirjana
authors.initials: M
authors.lastname: Doknic
authors.forename: Marina
authors.initials: M
authors.lastname: Nikolic-Djurovic
authors.forename: Dragan
authors.initials: D
authors.lastname: Micic
authors.forename: Rajko
authors.initials: R
authors.lastname: Hrvacevic
authors.forename: Vidosava
authors.initials: V
authors.lastname: Nesic
authors.forename: Vera
authors.initials: V
authors.lastname: Popovic
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006480:Hemorrhagic Fever with Renal Syndrome / Q000150:complications* / Q000503:physiopathology; D019382:Human Growth Hormone / Q000172:deficiency; D006801:Humans; D007018:Hypopituitarism / Q000453:epidemiology / Q000209:etiology*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010907:Pituitary Hormones / Q000172:deficiency; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D015995:Prevalence; D011388:Prolactin / Q000097:blood; D013974:Thyroxine / Q000097:blood
chemical_list: D010907:Pituitary Hormones; D019382:Human Growth Hormone; D011388:Prolactin; D013974:Thyroxine