Dobrava Hantavirus Infection Complicated by Panhypopituitarism, Istanbul, Turkey, 2010

Sarıgüzel, Nevin; Hofmann, Jörg; Canpolat, Alper Tunga; Türk, Ali; Ettinger, Jakob; Atmaca, Deniz; Akyar, Işın; Yücel, Serap; Ari̇kan, E. T.; Uyar, Yavuz; Çağlayık, Dilek Yağcı; Kocagöz, Ayşe Sesin; Kaya, Ayşin; Krüger, Detlev H.

doi:10.3201/eid1807.111746

Cited by 19 publications

(24 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Table 3 summarises eleven previous case reports (2, 3, 4, 5, 6, 8, 14, 15, 16, 17, 18) with 14 well-characterised cases of HFRS-related panhypopituitarism. Five patients were diagnosed with hypopituitarism requiring chronic hormonal replacement, starting from the acute phase of HFRS (3, 6, 15, 17, 18).…”

Section: Discussionmentioning

confidence: 99%

“…Five patients were diagnosed with hypopituitarism requiring chronic hormonal replacement, starting from the acute phase of HFRS (3, 6, 15, 17, 18). Nine patients developed late-onset panhypopituitarism months or years after HFRS (2, 3, 4, 5, 8, 14, 16).…”

Section: Discussionmentioning

confidence: 99%

“…(6)xxxN/AN/AAcuteAcute: Enlarged pituitary gland5 moPartial**5 mo: Normal (MRI)Sarigüzel et al . (17)xxxx b –AcuteHaemorrhage, atrophy (MRI)16 moNoKaybas et al . (18)xN/Ax–N/AAcuteNormal (MRI)N/AN/A

ACTH, adrenocorticotropic hormone; AVP, arginine vasopressin; d, days; FSH, follicle-stimulating hormone; GH, growth hormone; LH, luteinizing hormone; mo, months; N/A, data not available; TSH, thyroid-stimulating hormone; y, years.

GH/IGF-1 axis deficiency was diagnosed by determining a serum GH level, or b serum IGF-1 level or by conducting a c GH axis stimulation test.

Adrenocortical and thyroid axis recovered, and gonadal axis did not.

…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Autoimmune polyendocrinopathy and hypophysitis after Puumala hantavirus infection

Tarvainen

Mäkelä

Mustonen

et al. 2016

Endocrinology, Diabetes &Amp; Metabolism Case Reports

View full text Add to dashboard Cite

SummaryPuumala hantavirus (PUUV) infection causes nephropathia epidemica (NE), a relatively mild form of haemorrhagic fever with renal syndrome (HFRS). Hypophyseal haemorrhage and hypopituitarism have been described in case reports on patients with acute NE. Chronic hypopituitarism diagnosed months or years after the acute illness has also been reported, without any signs of a haemorrhagic aetiology. The mechanisms leading to the late-onset hormonal defects remain unknown. Here, we present a case of NE-associated autoimmune polyendocrinopathy and hypopituitarism presumably due to autoimmune hypophysitis. Thyroid peroxidase antibody seroconversion occurred between 6 and 12 months, and ovarian as well as glutamate decarboxylase antibodies were found 18 months after acute NE. Brain MRI revealed an atrophic adenohypophysis with a heterogeneous, low signal intensity compatible with a sequela of hypophysitis. The patient developed central (or mixed central and peripheral) hypothyroidism, hypogonadism and diabetes insipidus, all requiring hormonal replacement therapy. This case report suggests that late-onset hormonal defects after PUUV infection may develop by an autoimmune mechanism. This hypothesis needs to be confirmed by prospective studies with sufficient numbers of patients.Learning points:Pituitary haemorrhage resulting in hypopituitarism has been reported during acute HFRS caused by PUUV and other hantaviruses.Central and peripheral hormone deficiencies developing months or years after HFRS have also been found, with an incidence higher than that in the general population. The pathogenesis of these late-onset hormonal defects remains unknown.This case report suggests that the late-onset hypopituitarism and peripheral endocrine defects after HFRS could evolve via autoimmune mechanisms.The sensitivity of current anti-pituitary antibody (APA) tests is low. A characteristic clinical course, together with typical brain MRI and endocrine findings may be sufficient for a non-invasive diagnosis of autoimmune hypophysitis, despite negative APAs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

GH/IGF-1 axis deficiency was diagnosed by determining a serum GH level, or b serum IGF-1 level or by conducting a c GH axis stimulation test.

Adrenocortical and thyroid axis recovered, and gonadal axis did not.

…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Autoimmune polyendocrinopathy and hypophysitis after Puumala hantavirus infection

Tarvainen

Mäkelä

Mustonen

et al. 2016

Endocrinology, Diabetes &Amp; Metabolism Case Reports

View full text Add to dashboard Cite

show abstract

“…Extrarenal manifestations such as complications of the central nervous system (CNS) were observed in patients infected with Old World hantaviruses (Hautala et al 2002;Alexeyev and Morozov 1995;Ahlm et al 1998;Hautala et al 2010;Sariguzel et al 2012). Furthermore, severe pulmonary and cardiovascular involvement were described for PUUV and DOBV (Linderholm et al 1997;Connolly-Andersen et al 2013;Mentel et al 1999;Schutt et al 2004).…”

Section: Clinical Patterns and Pathogenesis Of Human Diseasementioning

confidence: 99%

Hantaviruses—Infections, Epidemiology and Hosts

Eßbauer

Krautkrämer

2014

Zoonoses - Infections Affecting Humans and Animals

View full text Add to dashboard Cite

Hantaviruses are pathogens of emerging importance in different areas of the world with local outbreaks as reported in 2012 in the Yosemite national park in the US or in several endemic areas in Germany. Quite recently hantaviruses have also been detected on the African continent. The knowledge on respective small mammal hosts and virus types/subtypes has rapidly increased in the last years now including also insectivores, bats and with these several associated new viruses. Usually animals are asymptomatic reservoir carriers, although a few studies show effects on rodent populations. In humans clinical symptoms of hantavirus infections are depending on the virus type causing syndromes of different severity. However, as infections are often clinically inapparent, recorded case numbers may be underestimated. The epidemiology of hantaviruses is complex as multiple biotic and abiotic factors are involved, e.g. rodent population density, corresponding virus prevalence, mast, habitats, biodiversity, rodent ecology, or climate and local weather parameters.

show abstract

“…Sarıgüzel ve ark. (14) DOBV alt tipine bağlı panhipopitü-tarizm gelişen erişkin olgu bildirmişlerdir. Bu yazıda, DOBV alt tipine bağlı gelişen ağır seyirli RSKA sonucu şifa ile taburcu edilen Bursa il merkezinde yaşayan 11 yaşındaki erkek çocuk olgusu sunulmuştur.…”

Section: Introductionunclassified