title: Long-term hormonal follow-up after human Puumala hantavirus infection.
abstract: OBJECTIVE
  Nephropathia epidemica (NE) is a haemorrhagic fever with renal syndrome (HFRS) caused by Puumala hantavirus (PUUV). Pituitary haemorrhage and hypopituitarism may complicate recovery from acute NE.
  
  
  METHODS
  Forty-seven of our recent cohort of 58 NE patients volunteered to be re-examined in order to estimate the burden of hormonal deficiency 4 to 8 years after the acute illness. Two patients had suffered from pituitary haemorrhage, but many others exhibited pituitary oedema during their acute infection. In this study, we searched for symptoms of hormonal deficiency, performed hormonal laboratory screening, and most patients underwent pituitary MRI examination.
  
  
  RESULTS
  The pituitary size had diminished in all patients in whom MRI was performed (P < 0·001). One patient with acute phase haemorrhage had made a complete recovery while the other continued to require hormonal substitution. In addition, hormonal laboratory abnormalities were observed in nine other patients; these being attributable to several reasons, for example independent peripheral hormonal diseases, side effects of medication or other secondary causes such as obesity. None of them had signs of late-onset pituitary insufficiency caused by their previous NE. Health-related quality of life (mean and median 15D score) of patients was comparable to that of age-standardized general population.
  
  
  CONCLUSIONS
  None of our patients had developed obvious late-onset hypopituitarism despite of the fact that pituitary gland can be affected during acute NE. We recommend requesting a history of hantavirus infection whenever the possibility of pituitary dysfunction is suspected at least in patients originating from regions with high NE infection rate.
authors.affiliation: Department of Internal Medicine, Oulu University Hospital, Oulu, Finland.
authors.forename: Terhi
authors.initials: T
authors.lastname: Partanen
authors.affiliation: Department of Internal Medicine, Oulu University Hospital, Oulu, Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Koivikko
authors.affiliation: Department of Internal Medicine, Oulu University Hospital, Oulu, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Leisti
authors.affiliation: Department of Internal Medicine, Oulu University Hospital, Oulu, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Salmela
authors.affiliation: Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
authors.forename: Eija
authors.initials: E
authors.lastname: Pääkkö
authors.affiliation: Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Karttunen
authors.affiliation: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: Harri
authors.initials: H
authors.lastname: Sintonen
authors.affiliation: Nordlab Oulu, Oulu, Finland.
authors.forename: Leila
authors.initials: L
authors.lastname: Risteli
authors.affiliation: Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.
authors.forename: Nina
authors.initials: N
authors.lastname: Hautala
authors.affiliation: Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Olli
authors.initials: O
authors.lastname: Vapalahti
authors.affiliation: Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Vaheri
authors.affiliation: Department of Internal Medicine, Oulu University Hospital, Oulu, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Kauma
authors.affiliation: Department of Internal Medicine, Oulu University Hospital, Oulu, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Hautala
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000150:complications / Q000175:diagnosis; D006480:Hemorrhagic Fever with Renal Syndrome / Q000150:complications / Q000821:virology*; D054884:Host-Pathogen Interactions; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010902:Pituitary Gland / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D010907:Pituitary Hormones / Q000097:blood / Q000172:deficiency*; D029262:Puumala virus / Q000502:physiology*; D011788:Quality of Life; D013997:Time Factors
chemical_list: D010907:Pituitary Hormones