Panhypopituitarism without pituitary ischemia after hantavirus infection

Damla Tufekci; Yasemin Emur Gunay; Ahmet Suat Demir; Beyhan Guvercin; Muhammet Cuneyt Bilginer; Hulya Coskun; Irfan Nuhoglu; Ozge Ucuncu; Kubra Kaynar; Mustafa Kocak

doi:10.1530/endoabs.73.AEP473

Introduction

Hantaviruses are a group of viruses causing hemorrhagic fever with renal failure syndrome (HFRS). HFRS is a disease characterized by bleeding, thrombocytopenia, increased vascular permeability, and acute renal failure. Hypopituitarism associated with HFRS often results from necrosis in the pituitary gland caused by ischemia or infarction. HFRS may be difficult to diagnose due to its unclear clinical features. In this report, we present a patient who developed panhypopituitarism with preserved pituitary function following HFRS.

Case presentation

A 43-year-old male patient presented to the emergency service due to the complaints of body pain, nausea, vomiting, diarrhea. On physical examination, the temperature was 38 °C and the diagnostics tests indicated kidney failure and thrombocytopenia (Table 1). The patient was diagnosed as having HFRS since the patient was positive for both hantavirus and Ig M/G and also had a suspicious history of contact with rodents. The patient was referred to our endocrinology clinic due to the development of hypotension, hypoglycemia and hyponatremia during medical treatment. The patient was also diagnosed with panhypopituitarism. The patient was initiated on methylprednisolone 3×20 mg therapy. After the completion of this therapy, levothyroxine 50 mg was added to the treatment and its dosage was gradually increased to 75 mg. Upon the improvement of clinical and laboratory findings, the steroid therapy was reduced and maintenance treatment was initiated with hydrocortisone 2×10 mg. Magnetic resonance imaging (MRI) revealed a normal pituitary gland in terms of both size and appearance. The patienet was initiated on intramuscular testosterone propionate (IM) 250 mg every 3 weeks due to the presence of hypogonadism.At a 6-month follow-up, pituitary MRI showed a normal pituitary gland in terms of size and appearance, and the patient is still being followed up in our endocrinology outpatient clinic due to panhypopituitarism.

Conclusion

Panhypopituitarism is an extremely rare complication that may arise following HFRS. Clinicians should keep this complication in mind even in patients with normal pituitary MRI findings and should promptly initiate replacement therapies to reduce morbidity and mortality.

Keywords: panhypopituitarism, hantavirus


	Value	Reference range
GH (μg/l)	0.08	< 3
IGF-1 (mg/ml)	22	58–215
FSH (IU/l)	1.01	1.27–19.26
LH (IU/l)	< 0.2	1.24–8.62
T. Testosterone (μg/l)	< 0.1	1.98–6.79
Prolactin (μg/l)	1.78	2.64–13.13
Cortisol (ug/dl)	1.25	35–430
ACTH	< 5.00	0.19–0.71
TSH (mIU/l)	0.26	0.41–6.8
sT3 (ng/l)	1.22	2.0–4.4
sT4 (ng/dl)	0.6	0.93–1.7

Endocrine Abstracts

AEP473