Long‐term hormonal follow‐up after human Puumala hantavirus infection

Partanen, Terhi; Koivikko, Minna; Leisti, Päivi; Salmela, Pasi; Pääkkö, Eija; Karttunen, Ari; Sintonen, Harri; Risteli, L.; Hautala, Nina; Vapalahti, Olli; Vaheri, Antti; Kauma, Heikki; Hautala, Timo

doi:10.1111/cen.12863

Cited by 19 publications

(21 citation statements)

References 21 publications

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“…Interestingly, the follow-up investigation of these two patients did not reveal any late-onset pituitary insufficiency [20].…”

Section: Discussionmentioning

confidence: 73%

“…The extent to which anterior pituitary insufficiency after hantavirus-associated pituitary bleeding recedes is not known due to the rarity of this complication, but the published cases indicate that a full recovery may occur [20]. The prognosis of malfunction of the posterior pituitary after hantavirus infection is unknown and should be studied in the future.…”

Section: Discussionmentioning

confidence: 99%

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When polyuria does not stop: a case report on an unusual complication of hantavirus infection

et al. 2020

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Background The clinical features, course and outcome of hantavirus infection is highly variable. Symptoms of the central nervous system may occur, but often present atypically and diagnostically challenging. Even though the incidence of hantavirus infection is increasing worldwide, this case is the first to describe diabetes insipidus centralis as a complication of hantavirus infection in the Western world. Case presentation A 49-year old male presenting with severe headache, nausea and photophobia to our neurology department was diagnosed with acute haemorrhage in the pituitary gland by magnetic resonance imaging. In the following days, the patient developed severe oliguric acute kidney failure. Diagnostic workup revealed a hantavirus infection, so that the pituitary haemorrhage resulting in hypopituitarism was seen as a consequence of hantavirus-induced hypophysitis. Under hormone replacement and symptomatic therapy, the patient’s condition and kidney function improved considerably, but significant polyuria persisted, which was initially attributed to recovery from kidney injury. However, water deprivation test revealed central diabetes insipidus, indicating involvement of the posterior pituitary gland. The amount of urine production normalized with desmopressin substitution. Conclusion Our case report highlights that neurological complications of hantavirus infection should be considered in patients with atypical clinical presentation.

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“…Interestingly, the follow-up investigation of these two patients did not reveal any late-onset pituitary insufficiency [20].…”

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

When polyuria does not stop: a case report on an unusual complication of hantavirus infection

et al. 2020

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“…Infections by Puumala hantavirus (PUUV), which are endemic zoonoses in some countries of Europe (especially in Northern Europe) and cause nephropathia epidemica (hemorrhagic fever with renal syndrome), may in some cases directly involve the pituitary gland. This may induce acute symptomatic hypophysitis and/or hemorrhage requiring hormone replacement therapy, but longterm sequela appears to be rare (Partanen et al 2016). Pituitary dysfunction, mainly central hypogonadism and rarely corticotroph insufficiency, has been reported in HIV patients (Mirza et al 2018).…”

Section: Viral Infectionsmentioning

confidence: 99%

Hypophysitis and Granulomatous Pituitary Lesions in Systemic Diseases

Jaffrain-Rea¹,

Filipponi²

2019

Endocrinology

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In clinical practice, expansive sellar lesions are largely represented by primary diseases of the pituitary gland, mostly pituitary tumors, which can be managed by endocrinologists and/or multidisciplinary pituitary teams. Hypophysitis has long been considered as a rare disease, and is classified on the basis of pathological findings, and as primary or secondary. Nowadays, an enlarging spectrum of pituitary and/or hypothalamic inflammatory, granulomatous, or even neoplastic disorders can be recognized, which may be part of systemic conditions and require appropriate multidisciplinary management involving a variety of specialists. For example, hypophysitis is being increasingly recognized in the setting of systemic IgG4-related disorders or as side effects of immune checkpoints inhibitors in oncological patients. Lymphocytic hypophysitis may sometimes be part of autoimmune polyendocrine syndromes. Significant knowledge has been added in the last decade in the pathogenesis and management of histiocytic disorders, which may infiltrate the pituitary and/or the hypothalamus Infective causes of pituitary inflammation should not be underestimated and are increasingly recognized in immunocompromised patients. Based on updated literature on these topics, this chapter aims to place pituitary inflammatory, granulomatous, and histiocytic disorders in their systemic context and stimulate multidisciplinary collaboration in order to optimize their diagnosis and clinical management.

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“…In a recent study, a group of patients suffering from Puumala hantavirus infections were followed long term. Two patients had pituitary hemorrhage during the acute phase of the disease, one of them recovered within a year after the acute illness and the other patient remained hypopituitary (81).…”

Section: Viral Hypophysitismentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Expanding the cause of hypopituitarism

Pekić

Popović

2017

European Journal of Endocrinology

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Hypopituitarism is defined as one or more pituitary hormone deficits due to a lesion in the hypothalamic-pituitary region. By far, the most common cause of hypopituitarism associated with a sellar mass is a pituitary adenoma. A high index of suspicion is required for diagnosing hypopituitarism in several other conditions such as other massess in the sellar and parasellar region, brain damage caused by radiation and by traumatic brain injury, vascular lesions, infiltrative/immunological/inflammatory diseases (lymphocytic hypophysitis, sarcoidosis and hemochromatosis), infectious diseases and genetic disorders. Hypopituitarism may be permanent and progressive with sequential pattern of hormone deficiencies (radiation-induced hypopituitarism) or transient after traumatic brain injury with possible recovery occurring years from the initial event. In recent years, there is increased reporting of less common and less reported causes of hypopituitarism with its delayed diagnosis. The aim of this review is to summarize the published data and to allow earlier identification of populations at risk of hypopituitarism as optimal hormonal replacement may significantly improve their quality of life and life expectancy.Correspondence should be addressed to V Popovic

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Long‐term hormonal follow‐up after human Puumala hantavirus infection

Cited by 19 publications

References 21 publications

When polyuria does not stop: a case report on an unusual complication of hantavirus infection

When polyuria does not stop: a case report on an unusual complication of hantavirus infection

Hypophysitis and Granulomatous Pituitary Lesions in Systemic Diseases

DIAGNOSIS OF ENDOCRINE DISEASE: Expanding the cause of hypopituitarism

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