Hantavirüse Bağlı Renal Sendromlu Hemorajik Ateş Sonrası Panhipopitüitarizm

Öz

Giriş: Renal Sendromlu Hemorajik Ateş (RSHA), Hantavirüs cinsine bağlı virüslerce oluşan akut bir viral hastalıktır. Hantavirüsler; ateş, dolaşım bozukluğu, kanama ve renal yetmezlik ile karekterize bir hastalık spektrumuna neden olurlar. Hipopitütiarizmin bilinen nedenleri pitüiter iskemi/infarkt ve nekroz olup klinik özelliklerinin belirsiz olmasından dolayı genellikle farkedilemezler. Bu yazıda, acil servise (AS) açıklanamayan hipoglisemi nedeni ile sevkedilen RSHA sonrası panhipopitüitarizm gelişen 60 yaşına erkek olgusunu sunduk. Olgu Sunumu: Biz acil servise RSHA sonrası gelişen panhipopitutuarizm beraber AS’ye açıklanamayan hipoglisemi ile başvuran 60 yaşında bir erkek hasta sunduk. Hastanın kan tetkiklerinde panhipopituitarizm ve anti-Hantavirüs IgG ve IgM pozitifliği tespit edildi. Hormon replasman tedavisi başlandı ve hasta ayaktan takibe alınarak tam iyileşme ile taburcu edildi. Sonuç: Panhipopituitarizm RSHA sonrası çok nadir görülen bir komplikasyondur. Morbidite ve mortaliteyi azaltmak için; acil tıp, dahili tıp ve enfeksiyon hastalıkları uzmanları bu komplikasyona karşı uyanık olmalıdırlar

Anahtar Kelimeler

• Renal sendromlu hemorajik ateş, panhipopitüitarizm, hantavirüs enfeksiyonu

Panhypopituitarism Following Hemorrhagic Fever with Renal Syndrome Due to Hantavirus

Öz

Introduction: Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease caused by viruses that belong to the genus Hantavirus. Hantaviruses produce a spectrum of illness characterized by fever, circulatory collapse, hemorrhages, and renal failure. Pituitary ischemia/infarction and necrosis are known causes of hypopituitarism, often remaining unrecognized because of subtle clinical manifestations. In this report, we present a case of a 60-year-old male patient who was referred to the emergency department (ED) for unexplained hypoglicemia, with panhypopituitarism following HFRS.Case Report: We, hereby, present a 60-year-old male patient admitted to the ED because of unexplained hypoglicemia, with panhypopituitarism following HFRS. Blood tests revealed panhypopituitarism and anti-hantavirus IgM and IgG positivity. Hormone replacement theraphy was initiated, and he was discharged for outpatient follow-up with total recovery.Conclusion: Panypopituitarism is an extremely rare complication of HFRS. Emergency medicine, internal medicine, and infectious diseases specialists should be aware of this complication to reduce mortality and morbidity

Anahtar Kelimeler

• Hemorrhagic fever with renal syndrome, panhypopituitarism, hantavirus infections

Kaynakça

1. Schmaljohn CS, Hasty SE, Dalrymple JM, LeDuc JW, Lee HW, von Bonsdorff CH, et al. Antigenic and genetic properties of viruses linked to hemorrhagic fever with renal syndrome. Science 1985; 227: 1041-4. [CrossRef]
2. Vapalahti O, Mustonen J, Lundkvist A, Henttonen H, Plyusnin A, Vaheri A. Hantavirus infections in Europe. Lancet Infect Dis 2003; 3: 653-61. [CrossRef]
3. Bi Z, Formenty PB, Roth CE. Hantavirus infection: a review and global update. J Infect Dev Ctries 2008; 2: 3-23. [CrossRef]
4. Pekic S, Cvijanovic G, Stonjanovic M, Kendereski A, Micic D, Popovic V. Hypopituitarism as a late complication of hemorrhagic fever. Endocrine 2005; 26: 79-82. [CrossRef]
5. Suh DC, Park JS, Park SK, Lee HK, Chang KH. Pituitary hemorrhage as a complication of hantaviral disease. AJNR Am J Neuroradiol 1995; 16: 175-8.
6. Settergren B, Boman J, Linderholm M, Wiström J, Hägg E, Arvidsson PA. A case of nephropathia epidemica associated with panhypopituitarism and nephrotic syndrome. Nephron 1992; 61: 234-5. [CrossRef]
7. Hautala T, Sironen T, Vapalahti O, Pääkkö E, Särkioja T, Salmela PI, et al. Hypophyseal hemorrhage and panhypopituitarism during Puumala Virus Infection: Magnetic Resonance Imaging and detection of viral antigen in the hypophysis. Clin Infect Dis 2002; 35: 96-101. [CrossRef]
8. Stojanovic M, Pekic S, Cvijovic G, Miljic D, Doknic M, Nikolic-Djurovic M, et al. High risk of hypopituitarism in patients who recovered from hemorrhagic fever with renal syndrome. J Clin Endocrinol Metab 2008; 93: 2722-8. [CrossRef]

9. Jovanović D, Kovacević Z, Dragović T, Petrović M, Tadić J. Anterior pituitary lobe atrophy as late complication of hemorrhagic fever with renal syndrome. Vojnosanit Pregl 2009; 66: 166-8. [CrossRef]
10. Ertek M, Buzgan T; Refik Saydam National Public Health Agency; Ministry of Health, Ankara, Turkey. An outbreak caused by hantavirus in the Black Sea region of Turkey, January-May 2009. Euro Surveill 2009; 14. pii: 19214.
11. Sarıgüzel N, Hofmann J, Canpolat AT, Türk A, Ettinger J, Atmaca D, et al. Emerg Infect Dis Dobrava hantavirus infection complicated by panhypopituitarism, Istanbul, Turkey, 2010. 2012; 18: 1180-3.