Patients who had hemorrhagic fever at risk for developing hypopituitarism

Hypopituitarism is the term used for the loss of multiple hormones which are produced in the pituitary. This is usually due to a pituitary adenoma and/or surgery to remove it. Less commonly, the apoplexy of a tumor or Sheehan's Syndrome are the cause. There are other rare causes such as sarcoidosis, histiocytosis and hemochromatosis. Recently, these authors discovered a disproportionate number of survivors of hemorrhagic fever with renal syndrome (HFRS) with hypopituitarism .

HFRS is caused by hantaviruses from the family Bunyaviridae and is usually acquired from rodents. This illness and similar illnesses are prevalent in the Europe and Asia, and American troops serving with the United Nations renamed it the "Korean hemorrhagic fever" when taken ill while serving in Korea in 1951.

HFRS survivors who had recovered from the illness were analyzed with multiple hormonal and imaging studies. Growth hormone, thyroid hormones, the total HPA-axis, and several other hormones were assessed. "[S]erum T4, free T4, TSH, IGF-I, prolactin, cortisol, and testosterone (in males) was followed by insulin tolerance test and/or GHRHGH-releasing peptide-6 stimulation tests."

The criteria for inclusion in the study included confirmation of hemorrhagic fever with renal syndrome infection from three major medical centers in Belgrade. The subjects of the study must have had a full recovery and been well for at least 6 months, with an average time of 2 years from recovery. There was a larger percentage of males versus females (14:1).

The more severe the HFRS was for the patient, the greater the degree of endocrine deficiency they acquired. Those with multiple pituitary hormone deficiencies (MPHD) were imaged and 80% of them showed empty sella syndrome with pituitary atrophy.

The authors state:

Postmortem analysis after hemorrhagic fever with renal syndrome revealed
hemorrhage and necrosis in the anterior pituitary in 50–100% of cases (37,
38)...[A]trophic changes in pituitary with consecutive hypopituitarism in our
patients are similar to those previously sporadically described (21). It is
possible that hypopituitarism is more common than is recognized and that it
should be considered in all patients who recovered from severe hemorrhagic fever
with renal syndrome.

Hypopituitarism, no matter what the cause, has serious implications on the lives of those affected. All too often, this goes undetected which markedly affects the length and quality of life in these individuals.


Stojanovic, M., Pekic, S., Cvijovic, G., Miljic, D., Doknic, M., Nikolic-Djurovic, M., Micic, D., Hrvacevic, R., Nesic, V., Popovic, V. (2008). High Risk of Hypopituitarism in Patients Who Recovered from Hemorrhagic Fever with Renal Syndrome. Journal of Clinical Endocrinology & Metabolism, 93(7), 2722-2728. DOI: 10.1210/jc.2008-0311