Department of Internal Medicine, Postgraduate Institute Medical Education and Research, Chandigarh, Himachal Pradesh, India.
Department of Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Neurol India. 2018 Sep-Oct;66(5):1351-1358. doi: 10.4103/0028-3886.241378.
Endocrinal insufficiency caused by vasculotoxic snake envenomation is under-recognized and is mostly confined to a specific geographic area. We conducted a prospective study to determine the prevalence and pattern of pituitary-target gland insufficiencies caused by snake envenomation.
The hormonal evaluation of patients who had suffered from vasculotoxic snake envenomation was done at baseline and at 6 months of follow-up. Those patients with a documented hormonal insufficiency underwent magnetic resonance imaging (MRI) of the hypothalamo-pituitary area. The severity of envenomation was assessed by the acute physiology and chronic health evaluation II (APACHE-II) score, the sepsis-related organ failure assessment (SOFA) score, and the snake bite severity score (SBSS) for all patients.
Seventy-six patients were seen during the study period, of which 60 were available for a repeat hormonal evaluation at 6 months, with the majority of patients belonging to the middle age group (mean age, 37.6 ± 14.9 years). The mean lag period at presentation was 32 ± 20 h. Thirty-five patients (46.1%) had coagulopathy, 20 patients (26.3%) had acute kidney injury (AKI), and 8 of 76 patients (10.5%) needed renal replacement therapy (RRT) in the form of hemodialysis. Six patients (out of 41 with vasculotoxic bites) developed chronic hypopituitarism, which was in continuation with the acute hypopituitarism that they developed. Growth hormone and glucocorticoid deficiencies were the most common endocrinopathies observed. The occurrence of hypopituitarism was observed only in patients with a vasculotoxic snake bite (due to Russell's viper); coagulopathy, renal insufficiency, or any of the scoring tools did not predict the occurrence of hypopituitarism.
Acute asymptomatic and chronic symptomatic or asymptomatic hypopituitarism are important sequelae of viper bite in a small proportion of patients and can occur in the presence of normal pituitary imaging. Routine prospective pituitary hormone screening should be done in all patients within the first 6 months of envenomation by the vasculotoxic snakebite as chronic pituitary dysfunction can often occur in these patients.
由血管毒素蛇咬伤引起的内分泌功能不全尚未得到充分认识，并且主要局限于特定的地理区域。我们进行了一项前瞻性研究，以确定由蛇咬伤引起的垂体靶腺功能不全的患病率和模式。
对患有血管毒素蛇咬伤的患者进行基线和 6 个月随访时的激素评估。那些有记录的激素功能不全的患者进行了下丘脑-垂体区域的磁共振成像（MRI）检查。所有患者的血管毒素蛇咬伤严重程度通过急性生理学和慢性健康评估 II（APACHE-II）评分、脓毒症相关器官衰竭评估（SOFA）评分和蛇咬伤严重程度评分（SBSS）进行评估。
研究期间共观察到 76 例患者，其中 60 例在 6 个月时可重复进行激素评估，大多数患者属于中年组（平均年龄 37.6 ± 14.9 岁）。出现的平均潜伏期为 32 ± 20 小时。35 例患者（46.1%）有凝血功能障碍，20 例患者（26.3%）有急性肾损伤（AKI），8 例患者（76 例患者中的 10.5%）需要血液透析形式的肾脏替代治疗（RRT）。6 例患者（41 例血管毒素咬伤患者中的 6 例）发展为慢性垂体功能减退症，这与他们发生的急性垂体功能减退症有关。生长激素和糖皮质激素缺乏是最常见的内分泌疾病。垂体功能减退症仅发生在血管毒素蛇咬伤（由于罗素蝰蛇）的患者中；凝血功能障碍、肾功能不全或任何评分工具均不能预测垂体功能减退症的发生。
急性无症状和慢性症状性或无症状性垂体功能减退症是少数患者被毒蛇咬伤的重要后遗症，并且在正常垂体成像的情况下也可能发生。在血管毒素蛇咬伤后的前 6 个月内，应常规对所有患者进行前瞻性垂体激素筛查，因为这些患者经常会出现慢性垂体功能障碍。
