High Risk of Hypopituitarism in Patients Who Recovered from Hemorrhagic Fever with Renal Syndrome
Context: 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...
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| Veröffentlicht in: | The journal of clinical endocrinology and metabolism 2008-07, Vol.93 (7), p.2722-2728 |
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| creator | Stojanovic, Marko Pekic, Sandra Cvijovic, Goran Miljic, Dragana Doknic, Mirjana Nikolic-Djurovic, Marina Micic, Dragan Hrvacevic, Rajko Nesic, Vidosava Popovic, Vera |
| description | Context: 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.
Subjects and 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 T4, free T4, 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).
Conclusion: 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. |
| doi_str_mv | 10.1210/jc.2008-0311 |
| format | Article |
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Objective: The aim of this study was to determine, for the first time, the prevalence of hypopituitarism among HFRS survivors.
Subjects and 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 T4, free T4, 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).
Conclusion: 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.</description><identifier>ISSN: 0021-972X</identifier><identifier>EISSN: 1945-7197</identifier><identifier>DOI: 10.1210/jc.2008-0311</identifier><identifier>PMID: 18430769</identifier><identifier>CODEN: JCEMAZ</identifier><language>eng</language><publisher>Bethesda, MD: Endocrine Society</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Endocrinopathies ; Feeding. Feeding behavior ; Female ; Fundamental and applied biological sciences. Psychology ; Hemorrhagic Fever with Renal Syndrome - complications ; Hemorrhagic Fever with Renal Syndrome - physiopathology ; Human Growth Hormone - deficiency ; Humans ; Hypopituitarism - epidemiology ; Hypopituitarism - etiology ; Hypothalamo-Hypophyseal System - physiopathology ; Hypothalamus. Hypophysis. Epiphysis (diseases) ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Middle Aged ; Non tumoral diseases. Target tissue resistance. Benign neoplasms ; Pituitary Hormones - deficiency ; Pituitary-Adrenal System - physiopathology ; Prevalence ; Prolactin - blood ; Thyroxine - blood ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Vertebrates: endocrinology</subject><ispartof>The journal of clinical endocrinology and metabolism, 2008-07, Vol.93 (7), p.2722-2728</ispartof><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c401t-fea28777afbb70c14f33bda65b79e1fab6245b31fbf341d2646460a08aa404203</citedby><cites>FETCH-LOGICAL-c401t-fea28777afbb70c14f33bda65b79e1fab6245b31fbf341d2646460a08aa404203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20499232$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18430769$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stojanovic, Marko</creatorcontrib><creatorcontrib>Pekic, Sandra</creatorcontrib><creatorcontrib>Cvijovic, Goran</creatorcontrib><creatorcontrib>Miljic, Dragana</creatorcontrib><creatorcontrib>Doknic, Mirjana</creatorcontrib><creatorcontrib>Nikolic-Djurovic, Marina</creatorcontrib><creatorcontrib>Micic, Dragan</creatorcontrib><creatorcontrib>Hrvacevic, Rajko</creatorcontrib><creatorcontrib>Nesic, Vidosava</creatorcontrib><creatorcontrib>Popovic, Vera</creatorcontrib><title>High Risk of Hypopituitarism in Patients Who Recovered from Hemorrhagic Fever with Renal Syndrome</title><title>The journal of clinical endocrinology and metabolism</title><addtitle>J Clin Endocrinol Metab</addtitle><description>Context: 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.
Subjects and 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 T4, free T4, 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).
Conclusion: 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Endocrinopathies</subject><subject>Feeding. Feeding behavior</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Hemorrhagic Fever with Renal Syndrome - complications</subject><subject>Hemorrhagic Fever with Renal Syndrome - physiopathology</subject><subject>Human Growth Hormone - deficiency</subject><subject>Humans</subject><subject>Hypopituitarism - epidemiology</subject><subject>Hypopituitarism - etiology</subject><subject>Hypothalamo-Hypophyseal System - physiopathology</subject><subject>Hypothalamus. Hypophysis. Epiphysis (diseases)</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Non tumoral diseases. Target tissue resistance. Benign neoplasms</subject><subject>Pituitary Hormones - deficiency</subject><subject>Pituitary-Adrenal System - physiopathology</subject><subject>Prevalence</subject><subject>Prolactin - blood</subject><subject>Thyroxine - blood</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><subject>Vertebrates: endocrinology</subject><issn>0021-972X</issn><issn>1945-7197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0M-L1DAYxvEgijuu3jxLLnqy65sf00yOsriOsKCsit7K2_TNTsa2qUmrzH9vhhn0IjnkkA9P4MvYcwFXQgp4s3dXEmBTgRLiAVsJq9eVEdY8ZCsAKSpr5PcL9iTnPYDQeq0eswux0QpMbVcMt-F-x-9C_sGj59vDFKcwL2HGFPLAw8g_4RxonDP_tov8jlz8RYk67lMc-JaGmNIO74PjN1Qe-O8wlzUaseefD2NXED1ljzz2mZ6d70v29ebdl-ttdfvx_Yfrt7eV0yDmyhPKjTEGfdsacEJ7pdoO63VrLAmPbS31ulXCt15p0clalwMIG0QNWoK6ZK9Ou1OKPxfKczOE7KjvcaS45Ka2Cmwt6gJfn6BLMedEvplSGDAdGgHNMWmzd80xaXNMWviL8-7SDtT9w-eGBbw8A8wOe59wdCH_dRK0tVLJ4tTJ0dhFl8JIU6Kcm31cUgmW___9HwmUj84</recordid><startdate>20080701</startdate><enddate>20080701</enddate><creator>Stojanovic, Marko</creator><creator>Pekic, Sandra</creator><creator>Cvijovic, Goran</creator><creator>Miljic, Dragana</creator><creator>Doknic, Mirjana</creator><creator>Nikolic-Djurovic, Marina</creator><creator>Micic, Dragan</creator><creator>Hrvacevic, Rajko</creator><creator>Nesic, Vidosava</creator><creator>Popovic, Vera</creator><general>Endocrine Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20080701</creationdate><title>High Risk of Hypopituitarism in Patients Who Recovered from Hemorrhagic Fever with Renal Syndrome</title><author>Stojanovic, Marko ; Pekic, Sandra ; Cvijovic, Goran ; Miljic, Dragana ; Doknic, Mirjana ; Nikolic-Djurovic, Marina ; Micic, Dragan ; Hrvacevic, Rajko ; Nesic, Vidosava ; Popovic, Vera</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c401t-fea28777afbb70c14f33bda65b79e1fab6245b31fbf341d2646460a08aa404203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Endocrinopathies</topic><topic>Feeding. Feeding behavior</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Hemorrhagic Fever with Renal Syndrome - complications</topic><topic>Hemorrhagic Fever with Renal Syndrome - physiopathology</topic><topic>Human Growth Hormone - deficiency</topic><topic>Humans</topic><topic>Hypopituitarism - epidemiology</topic><topic>Hypopituitarism - etiology</topic><topic>Hypothalamo-Hypophyseal System - physiopathology</topic><topic>Hypothalamus. Hypophysis. Epiphysis (diseases)</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Non tumoral diseases. Target tissue resistance. Benign neoplasms</topic><topic>Pituitary Hormones - deficiency</topic><topic>Pituitary-Adrenal System - physiopathology</topic><topic>Prevalence</topic><topic>Prolactin - blood</topic><topic>Thyroxine - blood</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><topic>Vertebrates: endocrinology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stojanovic, Marko</creatorcontrib><creatorcontrib>Pekic, Sandra</creatorcontrib><creatorcontrib>Cvijovic, Goran</creatorcontrib><creatorcontrib>Miljic, Dragana</creatorcontrib><creatorcontrib>Doknic, Mirjana</creatorcontrib><creatorcontrib>Nikolic-Djurovic, Marina</creatorcontrib><creatorcontrib>Micic, Dragan</creatorcontrib><creatorcontrib>Hrvacevic, Rajko</creatorcontrib><creatorcontrib>Nesic, Vidosava</creatorcontrib><creatorcontrib>Popovic, Vera</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of clinical endocrinology and metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stojanovic, Marko</au><au>Pekic, Sandra</au><au>Cvijovic, Goran</au><au>Miljic, Dragana</au><au>Doknic, Mirjana</au><au>Nikolic-Djurovic, Marina</au><au>Micic, Dragan</au><au>Hrvacevic, Rajko</au><au>Nesic, Vidosava</au><au>Popovic, Vera</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High Risk of Hypopituitarism in Patients Who Recovered from Hemorrhagic Fever with Renal Syndrome</atitle><jtitle>The journal of clinical endocrinology and metabolism</jtitle><addtitle>J Clin Endocrinol Metab</addtitle><date>2008-07-01</date><risdate>2008</risdate><volume>93</volume><issue>7</issue><spage>2722</spage><epage>2728</epage><pages>2722-2728</pages><issn>0021-972X</issn><eissn>1945-7197</eissn><coden>JCEMAZ</coden><abstract>Context: 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.
Subjects and 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 T4, free T4, 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).
Conclusion: 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.</abstract><cop>Bethesda, MD</cop><pub>Endocrine Society</pub><pmid>18430769</pmid><doi>10.1210/jc.2008-0311</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Aged Biological and medical sciences Endocrinopathies Feeding. Feeding behavior Female Fundamental and applied biological sciences. Psychology Hemorrhagic Fever with Renal Syndrome - complications Hemorrhagic Fever with Renal Syndrome - physiopathology Human Growth Hormone - deficiency Humans Hypopituitarism - epidemiology Hypopituitarism - etiology Hypothalamo-Hypophyseal System - physiopathology Hypothalamus. Hypophysis. Epiphysis (diseases) Magnetic Resonance Imaging Male Medical sciences Middle Aged Non tumoral diseases. Target tissue resistance. Benign neoplasms Pituitary Hormones - deficiency Pituitary-Adrenal System - physiopathology Prevalence Prolactin - blood Thyroxine - blood Vertebrates: anatomy and physiology, studies on body, several organs or systems Vertebrates: endocrinology |
| title | High Risk of Hypopituitarism in Patients Who Recovered from Hemorrhagic Fever with Renal Syndrome |
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