Predictors of hypopituitarism due to vasculotoxic snake bite with acute kidney injury

Bhat, Sowrabha; Mukhopadhyay, Pradip; Raychaudhury, Arpita; Chowdhury, Subhankar; Ghosh, Sujoy

doi:10.1007/s11102-019-00990-8

Cited by 8 publications

(14 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On further probing, she had undocumented weight loss. She was never symptomatic for hypotension or hypoglycemia, similar to asymptomatic patients reported in some studies (8). Lactation has been described in women with hypopituitarism (10), as was seen following an uneventful vaginal delivery in our patient.…”

Section: Discussionsupporting

confidence: 88%

“…The lag period before diagnosis can vary from a couple of weeks to a decade (9). The most common axis involved in acute presentation is hypocortisolism (3,4,8). Though hypocortisolism is usually due to secondary adrenal insufficiency, adrenal hemorrhage causing primary hypoadrenalism has also been described (3,7).…”

Section: Discussionmentioning

confidence: 99%

“…Up to half of patients with delayed hypopituitarism may be asymptomatic and diagnosed only by active surveillance (7,8). Prospective evaluation in survivors of vasculotoxic envenomation indicates that the initial insult occurs during the acute stage when patients may be asymptomatic and persists with progression to delayed hypopituitarism (7).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, anatomic-functional discordance can be seen sometimes in patients with diabetes insipidus or in normal subjects, especially in older age (17). In fact, both concordance and discordance can be seen between clinical and radiologic features in cases of envenomation-induced hypopituitarism both for anterior and posterior pituitary (4)(5)(6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Acquired Ectopic Posterior Pituitary Bright Spot Due to Vasculotoxic Snakebite

Das

Bhansali

Ahuja

et al. 2020

AACE Clinical Case Reports

View full text Add to dashboard Cite

Introduction Vasculotoxic envenomation is an uncommon cause of hypopituitarism. Most described cases have varying extent of anterior pituitary dysfunction, but posterior pituitary involvement is extremely rare. Methods Clinical, biochemical and radiologic evaluation of a young female who presented with secondary amenorrhoea was performed. A brief literature review of envenomation-induced hypopituitarism is included. Results A 26-year-old female presented with secondary amenorrhoea since the age of 20. She had normal stature. Her past medical history was significant for vasculotoxic snakebite 12 years back requiring hemodialysis, but no hormonal testing was done at that time. Current evaluation showed anterior hypopituitarism. Insulin-induced hypoglycemia test confirmed deficiencies of cortisol and growth hormone axes (peak values 348nmol/l and 0.03ng/ml). There was no diabetes insipidus. MRI revealed a hypoplastic anterior pituitary with an ectopic posterior pituitary. In view of normal stature and secondary amenorrhoea, a diagnosis of envenomation-induced hypopituitarism with ectopic posterior pituitary (EPP) was made. Brief literature review of envenomation-induced hypopituitarism showed both acute and delayed presentation, male predominance, variable lag period (weeks to years). Nearly half of all patients were asymptomatic. The most common axis involved in acute presentation was the cortisol axis, whereas thyroid and gonadotroph axes were commonly involved in delayed hypopituitarism. Conclusion Vasculotoxic envenomation is a rare cause of acquired hypopituitarism. EPP in the index case was probably due to the “axonal dieback” phenomenon and subsequent regeneration of the axons at a more caudal site. This case, being the first instance of acquired EPP following envenomation, expands the spectrum of envenomation-induced hypopituitarism.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Acquired Ectopic Posterior Pituitary Bright Spot Due to Vasculotoxic Snakebite

Das

Bhansali

Ahuja

et al. 2020

AACE Clinical Case Reports

View full text Add to dashboard Cite

show abstract

“…In the study by Bhat et al, the two primary predictors of development of hypopituitarism in patients were the number of hemodialysis required and the initial whole blood clotting time. 5 Local vascular occlusion by fibrin could be a major cause of the pituitary lesion but venom haemorrhagins may also contribute by damaging pituitary capillary endothelium. 4…”

Section: Discussionmentioning

confidence: 99%

Snake bite induced delayed hypopituitarism: a rare case report

Bhowmick¹,

Mukhopadhyay²,

Kar³

et al. 2020

Int J Res Med Sci

View full text Add to dashboard Cite

Hypopituitarism following snake bite induced AKI and dialysis is an uncommon complication. Often the presentation is delayed and Can present with a myriad of features. We present a case of a 27 year old male patient, with past history of snake bite and acute kidney injury (AKI) requiring dialysis and which subsequently resolved, presenting to us with fatigability and weakness, absence of secondary sexual character and poor academic performance. On examination, the patient had pale white and coarse skin. Hoarseness of voice was present. There was proximal upper and lower limb muscle weakness present with pseudo myotonia on examination. There was loss of axillary and pubic hair with low testicular volume. Routine reports suggested mildly elevated creatinine with severely elevated Triglyceride levels. Creatine phosphokinase (CPK) was raised. Hormonal profile revealed low free thyroxine (FT4) and serum 8 a.m. Cortisol but an inadequate increase in thyroid stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH) levels were suggestive of central hypopituitarism. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), Insulin-like growth factor 1 (IGF-1) levels were reduced. Neuroimaging revealed empty sella suggestive of pituitary apoplexy. The above were suggestive of delayed hypopituitarism following post snake bite dialysis mediated pituitary apoplexy. In all cases of snake bite, a common occurrence in our country the possibility of hypopituitarism should be kept in mind and the hormonal profile followed up closely along with the renal parameters.

show abstract

Clinical aspects of snakebite envenoming and its treatment in low-resource settings

Warrell¹,

Williams²

2023

The Lancet

View full text Add to dashboard Cite

Predictors of hypopituitarism due to vasculotoxic snake bite with acute kidney injury

Cited by 8 publications

References 13 publications

Acquired Ectopic Posterior Pituitary Bright Spot Due to Vasculotoxic Snakebite

Acquired Ectopic Posterior Pituitary Bright Spot Due to Vasculotoxic Snakebite

Snake bite induced delayed hypopituitarism: a rare case report

Clinical aspects of snakebite envenoming and its treatment in low-resource settings

Contact Info

Product

Resources

About