From the Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry 605006, India
From the Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry 605006, India.
QJM. 2015 Sep;108(9):719-28. doi: 10.1093/qjmed/hcv011. Epub 2015 Jan 27.
Chronic hypopituitarism following Russell viper envenomation (RVE) is a rare but well-recognized syndrome. The clinical features, associations, management and outcomes of RVE associated-acute hypopituitarism (AHP) are not well described.
To describe the clinical features, intensive care unit (ICU) management and outcomes of a series of patients with RVE-AHP and identify the clinical associations of RVE-AHP.
We describe a series of patients with prospectively identified AHP related to RVE and describe our findings comparing RVE with and without AHP and a systematic search of literature on AHP related to RVE.
We identified nine cases of AHP related to RVE. Unexplained hypoglycemia (100%) and hypotension (66.7%) were the most common findings at presentation. AHP occurred after a median of 9 (range, 2-14) days after severe envenomation and was associated with multi-organ dysfunction, lower platelet counts, more bleeding and transfusions when compared to patients with RVE alone. The presence of clinically defined capillary leak syndrome, disseminated intravascular coagulation and mortality were not different from those without AHP. Our systematic search yielded 12 cases of AHP related to RVE; data on associated clinical manifestations, therapy and ASV administration were not available in most reports.
AHP is a very rare complication of RVE. Unexplained hypoglycemia and hypotension should prompt evaluation for AHP in RVE. AHP is associated with severe RVE, multi-organ dysfunction, bleeding and need for transfusion. Prompt treatment with steroids may reduce mortality related to AHP in RVE.
响尾蛇咬伤后发生慢性垂体功能减退症是一种罕见但已被广泛认识的综合征。响尾蛇咬伤相关急性垂体功能减退症（AHP）的临床特征、相关性、治疗方法和结局尚未得到很好的描述。
描述一系列响尾蛇咬伤相关 AHP 患者的临床特征、重症监护病房（ICU）管理和结局，并确定响尾蛇咬伤相关 AHP 的临床相关性。
我们描述了一系列与响尾蛇咬伤相关的 AHP 患者，并描述了我们的发现，包括比较有和无 AHP 的响尾蛇咬伤患者的情况，以及对与响尾蛇咬伤相关的 AHP 的文献进行系统搜索。
我们确定了 9 例与响尾蛇咬伤相关的 AHP 患者。在就诊时，最常见的表现为不明原因的低血糖（100%）和低血压（66.7%）。AHP 发生在严重咬伤后中位数为 9 天（范围，2-14 天），与单独发生响尾蛇咬伤的患者相比，AHP 与多器官功能障碍、血小板计数较低、更多出血和输血相关。临床定义的毛细血管渗漏综合征、弥散性血管内凝血和死亡率与无 AHP 的患者无差异。我们的系统搜索结果显示 12 例与响尾蛇咬伤相关的 AHP 病例；大多数报告中均未提供与相关临床表现、治疗方法和有创机械通气相关的数据。
AHP 是响尾蛇咬伤的一种非常罕见的并发症。在响尾蛇咬伤中，不明原因的低血糖和低血压应提示评估 AHP。AHP 与严重的响尾蛇咬伤、多器官功能障碍、出血和需要输血相关。早期应用类固醇治疗可能会降低响尾蛇咬伤相关 AHP 的死亡率。
