Department of Viroscience, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Department of Internal Medicine, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Viruses. 2019 Apr 10;11(4):340. doi: 10.3390/v11040340.
Several case reports have described hypopituitarism following orthohantavirus infection, mostly following Puumala virus. The pathogenesis of this seemingly rare complication of orthohantavirus infection remains unknown. This review explores the possible pathophysiological mechanisms of pituitary damage due to orthohantavirus infection. In only three out of the 28 reported cases, hypopituitarism was detected during active infection. In the remaining cases, detection of pituitary damage was delayed, varying from two months up to thirteen months post-infection. In these cases, hypopituitarism remained undetected during the acute phase of infection or only occurred weeks to months post infection. Both ischemic and hemorrhagic damage of the pituitary gland have been detected in radiographic imaging and post-mortem studies in the studied case reports series. Ischemic damage could be caused by hypotension and/or vasospasms during the acute phase of hemorrhagic fever with renal syndrome (HFRS) while hemorrhage could be caused by thrombocytopenia, thrombopathy, and other known causes of coagulation disorders during orthohantavirus infection. Also, hypophysitis due to the presence of auto-antibodies have been suggested in the literature. In conclusion, a significant number of case reports and series describe hypopituitarism after orthohantavirus infection. In most cases hypopituitarism was diagnosed with a delay and therefore could very well be underreported. Clinicians should be aware of this potential endocrine complication, with substantial morbidity, and if unrecognized, significant mortality.
已有数份病例报告描述了 orthohantavirus 感染后出现垂体功能减退症，大多继发于普马拉病毒感染。这种 orthohantavirus 感染后看似罕见的并发症的发病机制尚不清楚。本综述探讨了 orthohantavirus 感染导致垂体损伤的可能病理生理机制。在报告的 28 例病例中，仅有 3 例在感染活跃期检测到垂体功能减退症。在其余病例中，垂体损伤的检测时间延迟，从感染后 2 个月到 13 个月不等。在这些病例中，垂体功能减退症在感染急性期未被检测到，或者仅在感染后数周至数月发生。在研究病例报告系列中，放射影像学和尸检研究均检测到垂体缺血和出血性损伤。缺血性损伤可能由肾综合征出血热（HFRS）急性期的低血压和/或血管痉挛引起，而出血可能由血小板减少症、血小板病和 orthohantavirus 感染期间其他已知的凝血障碍原因引起。此外，文献中还提出了由于存在自身抗体而导致的垂体炎。总之，大量病例报告和系列描述了 orthohantavirus 感染后出现垂体功能减退症。在大多数情况下，垂体功能减退症的诊断存在延迟，因此很可能报告不足。临床医生应意识到这种潜在的内分泌并发症，其发病率高，如果未被识别，死亡率也很高。
